National Pirogov Memorial Medical University, Vinnytsya
Introduction. In patients with arterial hypertension, the constant increase in blood pressure is associated with vascular remodeling and structural decrease in the lumen of the arteries as a result of thickening of the medial layer. This problem is particularly acute in patients with myocardial infarction, which already presents endothelial dysfunction.
Therefore, the study of the effect of the basic comprehensive treatment on achieving the target blood pressure values, the dynamics of brachial artery remodeling and endothelial dysfunction in patients after acute myocardial infarction with comorbid arterial hypertension is extremely relevant.
The aim of the study. To determine the effectiveness of basic complex treatment in achieving target blood pressure indicators, dynamics of shoulder artery remodeling and endothelial dysfunction in patients with acute myocardial infarction with ST segment elevation with comorbid arterial hypertension for two years.
Materials and methods. 22 patients were examined after acute myocardial infarction with ST segment elevation in conjunction with hypertension. The transferred second myocardial infarction in history was determined in 7 (31.8 %), cardiac insufficiency of IIII functional classes was determined in 100.0 % of cases. Patients received a general clinical examination: ECG, echocardiography, the lipid blood spectrum was determined, and reactive hyperemia was used in doppler agitation of the brachial artery. Treatment continued for two years: inhibitor angiotensin converting enzyme perindopril was used at a dose of 5.0-10.0 mg/day, βblocker biosoprolol 5.0-10.0 mg/day, hypolipidemic drug atorvastatin 20.0 mg/day and acetylsalicylic acid 75.0 mg/day.
Results. In the examined patients, a significant increase in the thickness of the intimamedia complex and the reduction of endothelialdependent vasodilatation were found, indicating the development of the remodeling of the brachial artery and endothelial dysfunction. After two years of treatment, positive dynamics was observed. The target level of blood pressure was reached at 100.0 %. There was a significant decrease in the thickness of the intima media complex, an increase in of endothelialdependent vasodilatation and improvement of their degrees, indicating a positive dynamics of the shoulder artery remodeling, endothelial dysfunction under the influence of therapeutic measures.
Conclusions. In patients after acute myocardial infarction in combination with hypertension, the achievement of the target level of blood pressure with optimal twoyear treatment gradually increased and in 6 months was determined at 70.0 %, after 12 months at 93.8 %, after 24 months at 100.0 %. In the examined patients, the treatment determined a significant increase in the thickness of the intimamedia complex and decreased endothelialdependent vasodilatation of the brachial artery. After treatment in 6, 12 and 24 months, a tendency towards the improvement in the brachial artery remodeling and endothelial dysfunction was determined. An individual analysis of the extent of disturbances in the brachial artery remodeling indices, despite the small number of individuals examined, showed a tendency to decrease the number of patients with II (moderate) thickness of the intimamedia complex and III (significant) degree of endotheliumdependent vasodilatation as a result of a transition to a less pronounced degree, which testifies to the positive dynamics of the brachial artery remodeling, endothelial function and the efficacy of the treatment.
- Bilous Z, Аbrahamovych О. The Peculiarities of the Endothelial Function, Blood Lipid Spectrum and Heart Rate Variability in Patients with Stable Angina, Depending on the Heart Rate Frequency. Lviv Clinical Bulletin. 2016;4(16):8-14. (Ukrainian). https://doi.org/10.25040/lkv2016.04.008
- Bogachev RS, Rafeenkova VS, Kober DV and others. Clinical aspects of vaso-and cardioprotection in patients with primary and repeated myocardial infarction. Cardiology. 2014;8:26–31. (Russian). https://doi.org/10.18565/cardio.2014.8.26-31
- Denesyuk VI, Deneseuk OV. Development of endothelial dysfunction of vascular remodeling and dyslipidemia in patients with unstable angina with comorbid arterial hypertension. Blood circulation and hemostasis. 2012;4:57-61. (Ukrainian).
- Kravchun PG, Lapshina LA, Glebova OB. Endothelial function and cardiohemodynamics in clusters separated by endothelin-1 levels in acute myocardial infarction and late post-infarction period. International Medical Journal. 2012;1:22-26). (Russian).
- Denesyuk OV, Denesyuk VI, inventors; Vinnitsa National Medical University named after Pirogov, the patent holder. Method of determining the degrees of endothelial dysfunction in cardiovascular diseases. Patent № 86394. 2013 December 02. (Ukrainian).
- Denesyuk OV, Denesyuk VI, inventors; Vinnitsa National Medical University named after Pirogov, the patent holder. Method of determination of degrees and prognosis of hypertrophy of the brachial artery in patients with unstable angina with comorbid arterial hypertension. Patent of Ukraine 92640. 2014 August 26. (Ukrainian).
- Parkhomenko AN, Irkin OI, Lutai NM, Stepura AA, Kushnir SP, Bely DA. Endothelial function in patients with acute myocardial infarction: connection with the course of the disease. Emergency Medicine. 2016;1(72):131-136. (Russian). https://doi.org/10.22141/2224-05126.96.36.1996.74478
- Roitman AP, Tanhilevich BM, Dolgov VV, Yakovlev VN. Dynamics of laboratory markers of endothelial dysfunction in the treatment of patients with unstable angina. Clinical medicine. 2012;90(9):43-46). (Russian).
- Semenkin AA, Novikov AI, Nechaev GI, Zhivilova LA, Fisun NI, Pritykina TV and others. Endothelial and metabolic effects of perindopril in patients with essential arterial hypertension. Cardiology. 2014;54(7):31-35. (Russian). https://doi.org/10.18565/cardio.2014.7.31-35
- Dimitropoulou C, Chatterjee A, McCloud L, Yetik-Anacak G, Catravas JD. Angiotensin, bradykinin and the endothelium. Handb Exp Pharmacol. 2006;(176 Pt 1):255-294. https://doi.org/10.1007/3-540-32967-6_8
- Li YS, Haga JH, Chien S. Molecular basis of the effects of shear stress on vascular endothelial cells. J Biomech. 2005;38(10):1949-1971. https://doi.org/10.1016/j.jbiomech.2004.09.030