Цель. Оценить частоту рефрактерной артериальной гипертонии (АГ) при резистентной АГ (РАГ) с наличием и отсутствием сахарного диабета (СД) 2-го типа, сравнить клинический фенотип, метаболический профиль и состояние эндотелиальной функции у больных СД в сочетании с рефрактерной АГ и неконтролируемой РАГ. Материалы и методы. В исследование включены 74 больных РАГ с СД и 119 больных РАГ без СД. Рефрактерную АГ диагностировали по отсутствию контроля артериального давления (АД) на фоне приема ≥5 антигипертензивных препаратов, включая тиазидный диуретик и Верошпирон. Отсутствие контроля АД при приеме 3–4 антигипертензивных препаратов соответствовало неконтролируемой РАГ. Проводили клинико-лабораторные и инструментальные исследования, включая пробу с реактивной гиперемией на плечевой артерии и допплерографическую оценку вазореактивности средней мозговой артерии (СМА) по тесту с гипервентиляцией и задержкой дыхания. Результаты. Частота рефрактерной АГ при наличии и отсутствии СД сопоставима (30 и 28%). Различий между больными СД с рефрактерной АГ и неконтролируемой РАГ по клиническому фенотипу, данным АД и эхокардиографии не выявили. Вместе с тем у больных СД с рефрактерной АГ имели место более высокие значения индекса инсулинорезистентности, резистина плазмы крови и постпрандиальной гликемии. Дополнительно больные СД с рефрактерной АГ отличались от группы неконтролируемой РАГ более низкими показателями эндотелийзависимой вазодилатации и реактивности СМА на гиперкапнию, а также более выраженным вазоконстрикторным ответом СМА на гипервентиляцию. Заключение. Частота рефрактерной АГ у больных с наличием и отсутствием СД не имеет значимых отличий. Больные СД с рефрактерной АГ характеризуются более неблагоприятным метаболическим профилем и большей степенью нарушения эндотелиальной функции, чем пациенты с неконтролируемой РАГ.

BACKGROUND: Damage of arterial walls in diabetes mellitus associated with arterial hypertension is major factor delivering lesion of target organs. Currently, enough data is not available about imaging and quantitative evaluations of arterial wall. There is no enough data available about the relations between MRI and inflammatory and metabolic markers in patients with resistant arterial hypertension concomitant with diabetes mellitus. AIMS: Quantitative assessment of the intensity of paramagnetic contrast enhancement of the arterial wall, in particular renal arteries walls, in relation with inflammatory and metabolic markers in patients with resistant arterial hypertension concomitant with diabetes mellitus. MATERIALS AND METHODS: The study groups were comprised of 28 patients (ageing 60,7±6,5 years) with resistant hypertension accompanied with diabetes mellitus and 17 patients (aging 57,7±5,0 years) with resistant hypertension without diabetes mellitus. The average systolic/diastolic pressure obtained from a 24-h monitor study was as high as 156,8±16,9/81,9,0±13,5 mm Hg in the group with diabetes and 154,8±11,9/88,5±10,4 mm Hg in the group without diabetes. The values of glycaemia, the level of glycated haemoglobin, and C-reactive protein were determined. The MRI studies were carried out using 1,5 Т MRI Toshiba Vantage Titan scanner. After that, the intravenous contrast enhancement has been carried out (with 0,5 М paramagnetic, as 0,2 ml/Kg). The index of enhancement (IE) was then calculated from these data, as a ratio of intensities of contrast-enhanced image to the initial nonenhanced MRI scan. RESULTS: The correlation was obtained for IE of arterial wall and data of blood pressure. Increased IE was correlated with ageing and hemodynamic factors. Also the correlation was observed for IE proximal, medium and distal parts of renal arteries and values of glycaemia and NOMA-index were obtained. Negatively correlated values for IE and adiponectin in the group with diabetes mellitus were obtained. The association between IE and C-reactive protein remained significant in the group without diabetes mellitus. CONCLUSIONS: MRI with contrast enhancement of arterial walls allows evaluating the anatomy of renal arteries and allows quantifying the pathophysiologic factors of their walls in patients with resistant hypertension accompanied with diabetes mellitus. MRI characteristics of the arterial wall were associated not only with hemodynamic and metabolic data, but also with markers of inflammation.

Aim: To investigate the effects of lisinopril on blood pressure and cerebrovascular reactivity (CVR) in patients with arterial hypertension (AH) and rheumatoid arthritis (RA). Materials and Methods. Fifteen patients with AH and RA (age of 61 (52; 64) years; blood pressure (BP) of 147.0 (142; 156)/87.0 (82; 90) mmHg) received lisinopril during a sixmonth open controlled study. Ambulatory BP monitoring and evaluation of CVR were performed twice: initially and at the end of the study. CVR was evaluated using transcranial Doppler ultrasound (TCD) of the middle cerebral arteries (MCA) in hyperoxia and hypercapnia. Results. Treatment with Lisinopril significantly decreased CVR parameters in hyperoxia test as follows: the MCA coefficient of blood flow velocity change and the reactivity index significantly decreased by –28.6% (–39.32; 2.90) (р=0.037) and by –39% (“77; 7) (р=0.010), respectively, after lisinopril treatment. Conclusions. Lisinopril exerted a significant antihypertensive effect and improved CVR during hyperoxia in patients with AH and RA.

In recent years, an increasing attention is paid to the development of vascular fibrosis in patients with arterial hypertension (AH). Particular importance is given to changes in the concentrations of matrix metalloproteinases (MMPs), which play a key role in the development of connective tissue disorders. As of today, research data on the levels of the MMP(2 and the MMP(9 in hypertensive patients and their changes due to treatments remain controversial. Data concerning the impact of renal sympathetic denervation on the changes in the MMPs concentrations in patients with resistant hypertension are unavailable. The objectives of the study were (1) to determine the contents of matrix metalloproteinases 2 and 9 and of their tissue inhibitor TIMP(1 in patients with resistant hypertension before and 6 months after the transcatheter renal artery sympathetic denervation; (2) to compare these parameters in cases of effective and ineffective invasive treatment; and (3) to study the interaction between the enzymes concentrations and blood pressure levels, including pulse pressure levels.

The aim of the study was to evaluate long-term antihypertensive and cardioprotective efficacy of renal denervation in patients with drug(resistant arterial hypertension. The study excluded patients with symptomatic hypertension, multiple renal arteries when the diameter of one or more arteries was less than 3 mm, and patients with severe kidney disease stage 4–5. According to these criteria, 73 people were selected for renal denervation procedure. Comparison of the initial data with the values obtained after 12 months demonstrated the presence of a significant continuous antihypertensive effect with blood pressure decrease by –29.1/–14.8 mm Hg in the office blood pressure levels and by –12.9/–7.8 mm Hg according to 24(h monitoring. The study showed a decrease in the myocardial mass of the left ventricle in individuals who initially had more pronounced left ventricular hypertrophy.

The aim of the study was to investigate the long-term changes in arterial blood pressure after sympathetic denervation of the renal arteries. The analysis included a total of 54 patients with resistant hypertension who underwent renal denervation and was monitored for 12 month. Arterial blood pressure within 6 months after the intervention was significantly lower compared with the initial values in these patients. After 12 months, there was a downward tendency in arterial blood pressure values. In addition, the number of responders to the sympathetic renal denervation increased by 11% by the end of the first year of the follow-up.

The work was done by using a complex of the modern clinical and instrumental methods. The authors present a new method that they developed for the distal renal sympathetic denervation. Data demonstrated that the effective renal denervation leads to a stable antihypertensive effect, reduction of the left ventricular mass, improvement of diastolic function, normalization of the cerebral arterial autoregulation, decrease in the severity of the structural changes in the brain, and improvement of carbohydrate metabolism in the presence of resistant hypertension associated with diabetes mellitus.