P2645Cardiovascular risk in patients with essential hypertension and nonalcoholic fatty liver disease comorbidity

Abstract

Abstract Very often acute myocardial infarction and stroke are recorded among patients with essential hypertension (EH) and non-alcoholic fatty liver disease (NAFLD), including non-alcoholic steatohepatosis (NASP), comorbidity. The aim of the study was to improve cardiovascular risk assessment in patients with combination of second stage EH and NASP, using the metabolism indexes, structural-functional indicators of heart and blood vessels. According to the study results of 170 patients with second stage of EH (98 (57.6%) were women and 72 (42.4%) - men), mean age 49.3±0.5) it was found that NASP was confirmed in 109 (64.1%) patients (SteatoTest - 0.41 units (S1-S2)). Total cholesterol (TC), triglycerides (TG), high density lipoproteins (HDL); very low (LDL) and low density (LDL) lipoproteins; atherogenic index (IA); lipoprotein (a) (Lp (a)), insulin, HOMA index, tumor necrosis factor α (TNFα)), adiponectin were determined among all patients. The instrumental examination included electrocardiography, echocardiography, daily blood pressure monitoring (DBPM), carotid arteries ultrasound, calculation of endothelial dysfunction index (EDI) (as the ratio of endothelial-dependent to endothelial-independent vasodilation) and arterial wall stiffness (AS). Statistical processing of the results was conducted by Microsoft Excel, STATISTICA for Windows 10.0 programs. The proaterogenic lipid spectrum changes (TC (7.7%, p=0.0009), TG (19.8%, p=0.02), LDL (11,8%, p=0.0009), IA (8,8%, p=0.04), increased levels of Lp (a) (58.0%, p=0.0007) TNFα (51.4%, p=0.01), insulin resistance (HOMA index - 3.3 units), decreased adiponectin level (44.3%, p=0.0002) were reported in patients with II stage EH and NASP comorbidity compared to patients with EH without fatty liver infiltration (p<0.05). Higher systolic (SBP) and pulse arterial pressure (PBP) (both office measurement and DBPM), daily SBP index “nondipper” (63.3% of patients, p<0.05); increased by 2 times the frequency of the registration of atherosclerotic plaques in both carotid arteries (p<0.05), increase in AS (15.7%, p=0.002) and EDI reduction (−12.5%, p=0.01) were determined in patients with II stage EH and concomitant NASP compared with EH patients without NASP. True (p<0.ehz748.096601) direct correlation bonds were established between the NASP and the level of TC (rs=0.38), TG (rs=0.31), LDL (rs=0.31), Lp (a (rs=0.51), insulin resistance (rs=0.47), TNF-α (rs=0.49), night SBP and PBP (rs=0.33 and rs=0.29), variability night SBP, AS (rs=0.41), reverse – with the level of adiponectin (rs=−0.48) and EDI (rs=−0.58). Thus, in patients with second stage EH NAFLD is associated with negative metabolic changes and structural and functional desorders of heart and blood vessels and can be considered as an additional factor of the overall cardiovascular risk increasing in patients with EH.