The aim of the article is to evaluate the efficiency of the combination antihypertensive therapy using treatment plan including lisinopril and carvedilol in patients with combined arterial hypertension and diabetes mellitus 2 type considering polymorphic marker option 2350 A/G gene angiotensin-converting enzyme. Materials and methods of the research. 58 patients having arterial hypertension stage II grade 2 and subcompensated diabetes mellitus 2 type were examined. The patients were grouped based on the polymorphism of genetic markers 2350 A/G gene of the angiotensin-converting enzyme. Group 1 (n = 13) patients with genotype A/A polymorphic marker 2350 A/G; group 2 (n = 45) with unfavorable genotype A/G and G/G polymorphic marker 2350 A/G. All patients received antihypertensive therapy with a combination of lisinopril and carvedilol. The patients received rosuvastatin 10 mg per day and acetylsalicylic acid of 75 mg daily dose. Moreover, all patients received hypoglycemic therapy using a combination of metformin and gliclazide. Before and after treatment blood pressure, body mass index, carbohydrate and lipid metabolism and structural-functional changes in the myocardium were evaluated. Results. In group with A/G and G/G variants of polymorphic marker 2350 A/G gene angiotensin-converting enzyme before treatment were significantly higher systolic blood pressure and diastolic blood pressure in comparison with the group of patients having genotype A/A (p<0,05). As a result of the therapy a significant decrease in blood pressure was observed in both groups (p<0.001). It should be noted that prior to treatment more pronounced disorders and structural-functional changes in the myocardium were observed in the group with A/G and G/G genotypes (p<0.05). After treatment the ejection fraction values tended to increase in the A/A genotype group, and a significant increase in patients with unfavorable genotypes (p<0.05) was noticed. In both groups, there was a significant volume decrease in the atria and the diameter of the aorta (p<0.05). There was a significant decrease in total cholesterol, triglycerides, low density lipoprotein cholesterol, having statistically significant increase in high density lipoprotein cholesterol (p<0,05) in patients of the groups 1 and 2 after treatment. Changes in carbohydrate profile after treatment established significant reduction in fasting blood glucose levels as in patients with genotype A/A, as genotypes A/G and G/G (p<0,05). Conclusions: It was found out that the genotype A/G and G/G polymorphic marker 2350 A/G gene angiotensin-converting enzyme in patients with arterial hypertension and diabetes mellitus 2 type associated with higher numbers of blood pressure, more pronounced myocardial hypertrophy and metabolic disorders than in patients with A/A genotype. Antihypertensive therapy with the inclusion of lisinopril and carvedilol showed its efficiency in both groups of patients. There was a significant decrease in blood pressure, improvement of the structural-functional parameters of the myocardium as well as the parameters of carbohydrate and lipid metabolism.
Keywords: arterial hypertension, diabetes mellitus type 2, antihypertensive therapy, genetic polymorphism
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