Aim . To assess the effect of visceral obesity on main artery elasticity and vascular age in patients with hypertension (HTN), obesity, and type 2 diabetes (T2D). Material and methods . A total of 320 patients with stage II-III HTN aged 4570 years were divided into 4 groups: isolated HTN (group 1), HTN and obesity (group 2), HTN, obesity and T2D (group 3), HTN and T2D without obesity (group 4). We assessed the clinical status, parameters of visceral obesity, main artery elasticity, and vascular age. We used nonparametric statistics, Spearman correlation analysis. Results . At least 50% of all patients had visceral obesity, despite no BMI-estimated obesity in groups 1 and 4: 57,5 vs 100,0 vs 100,0 vs 50,0% in groups 1, 2, 3 and 4, respectively (p 10 m/s was consistently more common among patients of group 3 compared with patients in groups 1 and 2 (77,0 vs 57,9 and 55,3%, respectively, p 1-3 =0,004, p 2-3 =0,006). Vascular age was significantly lower in group 1 compared with groups 3 and 4 (64,0 [57,8; 71,0] vs 69,0 [62,0; 73,0] and 69,5 [66,0; 74,3] years, respectively), as well as in group 2 compared with group 4 (64,0 [56,5; 70,5] vs 69,5 [66,0; 74,3] years). The 5-year risk of cardiovascular events was significantly higher among patients with hypertension, obesity and T2D and those with HTN and T2D without obesity, compared with patients with isolated HTN, and with those with HTN and obesity (5,9 [3,9; 7,9] and 6,5 [4,7; 8,7] vs 4,4 [2,7; 6,8] and 3,6 [2,4; 5,8], respectively). Correlation analysis revealed the relationship between the visceral obesity parameters, main artery elasticity, vascular age and the 5-year risk of cardiovascular events, demonstrating the special aspects of HTN course in each of the studied groups. Conclusion . The paper showed peculiarities of the effect of visceral obesity on main artery elasticity and vascular age in patients with HTN in combination with obesity and T2D.

Aim. To study the state of the main arteries and vascular age in conjunction with the level of leptin and adiponectin in patients with arterial hypertension (AH) and obesity. Material and methods . One hundred and twenty patients with AH stage II aged from 45 to 65 years were divided into 3 groups depending on body mass index (BMI). Group 1 was represented by patients with AH and normal BMI, the 2 group was represented by patients with AH and excessive BMI, the 3 group was represented by patients with AH in combination with obesity. A standard clinical examination was performed, the stiffness of the vascular wall was measured by measuring the pulse wave velocity (PWV) of the muscle and elastic vessels (PWVe), vascular age was calculated, and the laboratory markers of obesity were determined. Results. High percentage of visceral obesity was observed: 20,0% among people with normal BMI, 64,4% among overweight people and 100% among people with obesity (differences between 1 and 2, 1 and 3, 2 and 3 groups are reliable). A statistically significant increase in PWVe was detected in patients with AH and obesity in comparison with patients with AH and normal body weight (9,8 [8,5; 11,3] vs 8,0 [79; 8,1] m/s). Vascular age was higher in patients with AH and overweight or obesity compared with patients with AH and normal weight (670 [60,0; 76,0], 68,0 [60,0; 72,0] vs 58,0 [57,0; 60,0] years, respectively). A statistically significant increase in the concentration of leptin (6,9 [4,5; 15,1] vs 19,0 [74; 42,7] vs 53,8 [38,4; 75,8] ng/ml) was detected, as well as a decrease in adiponectin concentration from the 1 to the 3 group (44,9 [36,6; 55,8] vs 16,5 [12,5; 24,7] vs 18,6 [15,3; 22,4] ng/ml, respectively). Correlation analysis revealed the presence of highly reliable relationships between the parameters of rigidity of the main arteries and laboratory markers of obesity. Conclusion. The results indicated a negative effect of hyperleptinemia and hypoadiponectinemia on the elasticity of the vascular wall of the main arteries and the vascular age in hypertensive patients with its combination with overweight or obesity.

THE AIM. To study the renal function and the severity of insulin resistance (IR), followed by evaluation of the combined risk of progression of chronic kidney disease (CKD) and cardiovascular complications in patients with obesity and existing cardiovascular disease (CVD). PATIENTS AND METHODS. The study included 140 patients with CVD between the ages of 45 to 70 years. Patients were divided into four comparable in age, sex, smoking, presence / absence of arterial hypertension (AH) and chronic heart failure (CHF), duration of hypertension, functional class (FC) of CHF, the level of office systolic blood pressure (SBP) and diastolic blood pressure (DBP) groups depending on the body mass index (BMI). We assessed the general condition, the clini- cal measurement of the heart rate (HR), and office BP in both arms according to standard procedure, the definition of CHF FC on 6-minute walk test, anthropometry with BMI calculation, measurement of waist circumference (OT) and hip circumference (ON) and body composition by the bioelectric impedance analysis. We also determined proteinuria (PU), albuminuria (AU), calculated glomerular filtration rate (GFR). We analyzed the combined risk of CKD progression and cardiovascular complications, depending on the GFR and the AU. To assess the current IR we used index HOMA-IR, triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C) ratio and the metabolic index (MI) with the use of carbohydrate and lipid parameters. RESULTS. There was a significant increase in the level of PU among patients group 4 compared to group 1 (560,19 ± 454,59 mg / g vs 330,8 ± 85,0 mg / g) and a statistically significant decrease in GFR in patients 3 and 4 groups compared with patients of group 1 (65,83 ± 13,39 and 64,06 ± 14,52 ml / min / 1.73 m 2, respectively, vs 74,94 ± 13,68 ml / min / 1.73 m2). Reliable average power detected correlation between the severity of visceral obesity and AU (r = 0,452), PU (r = 0,360), and GFR (r = -0,491). Analysis of the combined risk of CKD progression and cardiovascular complications showed a significant increase in very high-risk patients in the comparison group and 4 patients 1, 2 and 3 groups (68,6% vs 25, 39.8 and 40%, respectively). In assessing the indices that characterize the severity of IR, a statistically significant increase in HOMA-IR, TG / HSLPVP, MI with increasing BMI from group 1 to group 4 was established. We noted a high fidelity direct strong correlation between the level of visceral fat in the body, and HOMA-IR (r = 0,821), TG / HSLPVP (r = 0,806), MI (r = 0,812). CONCLUSION. The study showed a statistically significant progressive deterioration of renal function and an increase in the severity of IR as well as the increase in the combined risk of progression of CKD and cardiovascular events in patients with CVD with an increase in obesity during the comparable values of SBP office, DBP office and CHF FC among the studied groups. There were significant correlations between parameters of renal function and visceral obesity.

THE AIM: to study skin microcirculation (MC) characteristics in hypertensive patients with diabetes mellitus (DM) type 2 depending on stage of chronic kidney disease (CKD). PATIENTS AND METHODS. Study included 120 patients with arterial hypertension stage II-III aged from 40 to 65 years. Patients were divided into groups depending on stage of CKD. We evaluated overall state, clinical heart rate measurement and blood pressure (BP) on both hands with the patient sitting in the standard method, anthropometry, analysis of combined risk of CKD progression and cardiovascular complications development. We also studied skin microcirculation (MC) by Laser Doppler flowmetry (LDF) and determined renal function, HbA1c level. RESULTS. Significant increase of patients with a reduction in tissue blood flow with the worsening of CKD from stage S1 to S3b was revealed. Number of patients with severe venous flow (stasis) was significantly greater among 3 groups compared with those 2 groups (31,9 vs 15,6%, p<0,05). Regardless of CKD stage hyperemic hemodynamic type of MC (GTMC) was prevailed among patients with hypertension and type 2 diabetes. During renal function analysis we noted that proteinuria (PU) level was lower in group 1 patients compared with patients 2, 3 and 4 groups (426,4 ± 49,4 vs 623,9 ± 61,4 vs 734,3 ± 60,1 vs 737,3 ± 85,2 mg / g, respectively, p <0.05). Albuminuria (AU) level significantly increased from 1 to 4 patients group with hypertension and type 2 diabetes. During correlation analysis we found statistically significant relationships between renal function and the skin MC parameters. There were significant correlations between AU level and MC indicator (r = -0,15, p<0,05), PU and MC indicator levels (r = -0,35, p<0,05), PU and tissue oxygen consumption (r = -0,34, p<0,05). It was shown that with CKD severity increase tissue blood flow decreased - direct correlation between GFR (CKD-EPI) and tissue oxygen consumption (I) (r = 0,20, p <0.05) was noted. CONCLUSION. Thus, skin MC indicators change reflects prognosis of combined risk of CKD progression and cardiovascular complications in hypertensive patients with type 2 diabetes.

Aim: To study endothelial function and renal function in patients with arterial hypertension (AH) combined with diabetes mellitus (DM) type 2. Materials and methods. The study included 120 patients with arterial hypertension stage II-III in age from 40 to 65 years: 60 diabetic hypertensive patients (study group) and 60 non-diabetic hypertensive patients (control group). We studied endothelial and renal function. Results. We carried out a parallel analysis of the plasma parameters and organs (urine) component of endothelium in relation to the assessment of renal function. We found a statistically significant increase in the concentration of endothelin 1 (ET-1) in serum and decrease of nitric oxide metabolites (NO) in the urine of hypertensive patients with type 2 diabetes compared with those without type 2 diabetes (1,81 ± 0,07 vs 1,54 ± 0,07 pg / ml and 654,7 ± 45,9 vs 792,1 ± 39,4 M, respectively). In assessing renal function had higher values of proteinuria (PU), albuminuria (AU), as well as reduced glomerular filtration rate (GFR) in the intervention group compared with the control (775,2 ± 40,2 vs 476,5 ± 32, 9 mg / g, 323,3 ± 9,7 vs 190,6 ± 13,1 mg / g 59,2 ± 1,2 vs 74,6 ± 1,8 ml / min / 1.73 m2, respectively, p <0.05). There were significant correlation between endothelial and renal function. Conclusion. The study shows that while the comparable values of SBP office and DBP office the severity of endothelial dysfunction was significantly higher among patients with hypertension combined with type 2 diabetes compared to patients with hypertensive patients without type 2 diabetes. The results of evaluation of the urinary and plasma components of endothelial function in parallel with the analysis of renal function lets to assume that the forecast of hypertensive patients with type 2 diabetes determines not only from the initial value of BP, as the state of the target organ (endothelium, kidney).

THE AIM: to study the characteristics of cardiorenal relationships in hypertensive patients with diabetes mellitus (DM) type 2. PATIENTS AND METHODS. The study included 120 patients with arterial hypertension stage I-III in age from 40 to 65 years: 60 diabetic hypertensivepatients (studygroup) and 60 non-diabetichypertensive patients (control group). We performed ambulatory blood pressure monitoring, echocardiography, studied endothelial function, evaluated the artery stiffness, estimated renal function and metabolic parameters. RESULTS. A prognostic unfavorable changes of ambulatory blood pressure profile, a significantly higher incidence of left ventricular hypertrophy (LVH) were found in diabetic hypertensive patients in comparison with non-diabetic hypertensive patients. There were no patients with normal diastolic left ventricular function in the study group. Increased pulse wave velocity (PWV e.) was noted in 83.3 % diabetic hypertensive patients. More severe endothelial dysfunction, tubular and glomerular dysfunction were identified in diabetic hypertensive patients in comparison with non-diabetic hypertensive patients. Severe insulin resistance (IR) leaded to metabolic changes - glucosetoxicity, lipidotoxicity in diabetic hypertensive patients. CONCLUSION. The study shows the presence of cardiorenal interactions and interrelations between IR and target organ damage in hypertensive patients with type 2 diabetes. IR can be considered as an independent predictor cardiovascular and renal disease. Accordingly, IR correction will help us to optimize the results of treatment cardiovascular diseases and kidneys diseases in hypertensive patients with type 2 diabetes.