CLINICAL FEATURES OF MANAGEMENT OF PATIENTS WITH HYPERURICEMIA IN COMBINATION WITH ARTERIAL HYPERTENSION AND CHRONIC HEART FAILURE

Abstract

Objective: To evaluate clinical and diagnostic features of patients with AH and CHF combined with hyperuricemia. Design and method: The study included 49 patients divided into two groups: Group 1 - 32 patients with AH and CHF on the background of elevated uric acid (UA) 24(75%) men, 8 (25%) women, median age 66.0 (59.0;75.0) years and Group 2 - 20 patients with AH and CHF without hyperuricemia: 13 (65%) men, 7 (35%) women, median age 69.0 (63.0;73.5) years). Clinical data, laboratory and instrumental investigations were analyzed. Results: Comparative analysis showed that patients in the group with normal MC levels compared to patients in the hyperuricemia group had higher SCF (62 and 57 ml/min/1.73 m2 (p=0.04) respectively). A negative correlation of medium strength between blood MC level and LVEF was also observed, with lower values in group 1 patients (52.4 and 59.5, respectively). Differences were also observed when NTproBNP level was determined (385.5-2500.4) (R=-0.64 p<0.01). Separately it should be noted that out of 32 patients included in the study, 6 patients showed resistance to standard doses of diuretics, which required intensification of therapy in the form of increasing their dose. In a comparative analysis, MC levels were significantly higher in patients who subsequently underwent intensified therapy compared with patients with a satisfactory response to standard diuretic doses [543.8 (459.4-719.9) and 485(422.4-605.4), respectively; p=0.011]. Conclusions: The performance of this study further confirmed the high prevalence of hyperuricemia in AH and CHF. Moreover, the severity of hyperuricemia increased in parallel with the increase in the severity of CHF (according to NYHA FC and NUP concentration). Therefore, the patient management strategy should include screening and correction of purine metabolism. One of the main tasks in the algorithm of management of patients with hyperuricemia is rationalization of therapy with the main focus on cardiovascular risk factors and metabolic safety of drugs.