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    Daniuk I. O.

    THE FEATURES OF THE LEFT VENTRICLE REMODELING IN PATIENTS WITH SYMPTOMATIC HYPERTENSION ON THE GOUT BACKGROUND AND THE TREATMENT OPTIMIZATION


    About the author: Daniuk I. O.
    Heading CLINICAL MEDICINE
    Type of article Scentific article
    Annotation Gout is the most common cause of inflammatory arthritis in men elder than 30 years. Hypertension is diagnosed in about 80 % of patients with gout. Left ventricle (LV) remodeling is the logical process of myocardium restructuring in patients with hypertension. Aim of research. The aim of the study was to determine the structural parameters of the LV in patients with gout and symptomatic hypertension and to assess the effect of angiotensin receptor blocker II and calcium channel blocker combination on the process of reverse LV remodeling. Material and methods. We studied 50 men with primary gout, which combined with hypertension syndrome, 30 men with essential hypertension and 20 healthy men. The first and the second groups were comparable in duration and degree of hypertension. We determined the main basic parameters of LV, using ECHO-CS. Index of myocardial mass of the LV and the relative wall thickness have been calculated for researching LV geometry. We used the combination of losartan and lercanidipine for hypertension correction in patients with gout for 24-weeks. Statistic assessment of the figures obtained has been carried out by the programs STATISTICA 6.0. The difference between the variables was statistically significant at a level of significance test p<0, 05. Results. It was found the statistically significant increase of the volumetric parameters of LV in patients with gout which combined with hypertension in compared to the comparison groups and significant decrease of the ejection fraction on 8,3 % (p=0,001) in compared with the healthy men. We determined the significant thickening of the LV walls in patient of the main group and essential hypertension group in compared to the healthy men. It was found the significantly higher rates of myocardial mass and index of myocardial mass of the LV in patients with gouty hypertension in compared the comparison groups. Using the multivariate analysis of variance, we determined an effect of the systolic blood pressure (p=0,002), diastolic blood pressure (p=0,004), gout duration (p=0,02) and the presence of abdominal obesity (p=0,04) on LV remodeling process in gout patients. The increase of serum uric acid concentration correlated with the increase of myocardial mass (r = +0,3, p<0,05) and index of myocardial mass (r = +0,4, p<0,05) of the LV in this patient group. The most of the patients from the main group had the concentric hypertrophy geometry of the LV (44 %). After 24-week medical correction of hypertension in patients with gout by combination of losartan and lercanidipine we determined the significant regression of myocardial mass and index of myocardial mass of the LV and the tendency of modification of the geometry types. Conclusion. 1. Development of hypertension in patients with gout leads to a more pronounced LV remodeling in compared to patients with essential hypertension, in terms of comparability of the degree and duration of hypertension. 2. The degree of hypertension, gout duration and the presence of abdominal obesity significantly affect to the LV remodeling in gout patients with and hypertension syndrome. 3. 24-week correction of hypertension in patients with gout by combination of losartan and lercanidipine significantly improved LV structural indicators.
    Tags gout, hypertension, left ventricle remodeling, losartan, lercanidipine
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    Publication of the article «World of Medicine and Biology» №4(53) 1 part 2015 year, 028-031 pages, index UDK 616 – 002.78:616.12 – 008.331. 1:616.124.2]-08