ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 21 of 60
УЖМБС 2019, 4(6): 150–156
Clinical Medicine

Structural and Functional State of the Heart in Hypertension, Depending on Body Mass Index and the Presence of Insulin Resistance

Kochuieva M. M.1 , Psarova V. G. 1, Kyrychenko N. M. 2, Ruban L. A. 3, Komissarova O. S. 4, Shalimova A. S. 5

The combination of hypertension (AH) with obesity contributes to the faster advancement of the patient on the cardiovascular continuum. Many links in the mechanisms of AH development and progression and obesity remain unexplored. Further clarification of the interrelation between the main pathogenetic factors with indicators of structural and functional state of the heart and blood vessels will contribute to the deepening of knowledge about the mechanisms of damage to the main target organs in patients with this prognostically unfavorable condition. The purpose of the work was to evaluate the structural and functional state of the heart in AH, depending on BMI and the presence of IR. 174 AH patients aged 45–55 were examined who gave informed written consent to participate in the study and met the inclusion criteria. Patients were divided into groups according to body weight: the first group consisted of 40 patients with normal body weight, to 2–group 45 patients with overweight, to the 3rd group of 47 patients with obesity I, up to the 4th group 42 patients with grade II obesity. All groups were matched for age, sex, stage, grade of AH, functional class (FC) of chronic heart failure (CHF). Ultrasound scan of the heart and aorta was in one–, two–dimensional and Doppler modes with color mapping by conventional methods. HOMA–IR values of 2.77 or more were regarded as having insulin resistance (IR). As a result of the study, it was established that in the absence of significant differences in the ejection fraction (EF), body mass growth was associated with an increase in the relative thickness of the left ventricle (p <0.01), of the left ventricular myocardial mass index (p <0.05), of the volume of the left atrium (p <0.05), of course the diastolic diameter of the left ventricle (p <0.05), and of course the systolic diameter of the left ventricle (p <0.05) also. . In significantly (p <0.01) more patients with obesity, the signs of diastolic dysfunction in the form of impaired relaxation were diagnosed. The presence of IP was associated with more pronounced abnormalities of myocardial contractility in the absence of significant differences in the EF while the assessment of diastolic function did not show significant differences in groups, but there was a trend of changes in indicators (increased pulmonary artery pressure, E / e, decrease in E / A), which indicated a progression of diastolic dysfunction. The percentage of hypertensive patients with normal transmissible blood flow under conditions of presens IR is significantly (p <0.01) lower than in the absence of IR.

Keywords: hypertension, obesity, insulin resistance, systolic and diastolic heart function

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