Факторы, влияющие на сосудистую реактивность и скорость клубочковой фильтрации у больных артериальной гипертензией молодого и среднего возраста в зависимости от наличия сахарного диабета 2‑го типа

Abstract

Objective. To evaluate the impact of clinical, hemodynamic, metabolic and inflammatory indicators on the state of vascular reactivity and glomerular filtration rate in patients with arterial hypertension (HTN) in combination with type 2 diabetes mellitus (T2DM). Design and methods. We carried out a comparative descriptive study of two parallel groups of young and middle-aged patients with HTN 1–2 degrees: 72 patients with T2DM (group 1) and 61 patients without T2DM (group 2). We determined anthropometric, metabolic indicators, intima-media thickness (IMT) and endothelium-dependent vasodilation (EDVD) of brachial artery (BA) using a cuff test, glomerular filtration rate (GFR), the levels of interleukin‑1β and TNF-α, and 24‑h blood pressure (BP) monitoring was performed in all patients. Results. The BA diameter, EDVD indicators, cytokine activity were lower, while night SBP and 24h DBP time index were higher in group 1 compared to group 2. Based on the multivariate analysis the Models Summary were calculated for predicting GFR values and EDVD depending on the presence of T2DM, they explained ≥ 84,0 % variability of these parameters. Conclusions. We have developed the models to calculate the values EDVD, including common parameters for both groups (BA diameter, IMT, gender) and different indicators (time index of nocturnal DBP for the patients with T2DM; body mass index, 24‑h time index of DBP, TNF-α for the patients without T2DM). An independent association between GFR and time indices of daytime SBP, 24‑h SBP, left ventricular myocardial mass index and duration of T2DM was found only in group 1.