Peculiarities of influence of risk factors and cardiometabolic disorders on the course of hypertension with comorbid complications

Abstract

Objective — to determine the clinical features of the influence of risk factors and cardiometabolic disorders on the course of arterial hypertension (AH) with comorbid complications. Materials and methods. The study included the results of a survey of 580 patients (according to case histories) — 260 (44.8 %) female and 320 (55.2 %) male aged 20 to 88 years (mean age 59.34 ± 8.48) with AH stage II — III, who were examined and treated in the clinic of the State Institution «National Institute of Therapy. L. T. Malaya of National Academy of Medical Sciences of Ukraine” (Kharkiv). All patients had their blood pressure, body weight, height measured, fat and muscle tissue ratios evaluated, and physical activity was determined using pedometers. The indicators of distribution of adipose tissue were calculated: the percentage of fat deposits (PFD), body fat mass (BFM), fat mass index (FMI) according to known formulas. Indicators of carbohydrate, lipid and purine metabolism were evaluated. Results. The severity of the AH was associated with a lower percentage of alcohol consumption (p = 0.012), higher blood pressure levels (p < 0.001), higher functional class of chronic heart failure (CHF) (p < 0.001), more frequent detection of fasting hyperglycemia in patients (p < 0.001), the development of type 2 DM (p < 0.001) and diabetic nephropathy (p < 0.001). The markers of visceral obesity (PBF, BFM and FMI) correlated significantly with a low level of daily physical activity (p ≤ 0.002), a higher degree of AH (p ≤ 0.001), a higher functional class of CHF (p ≤ 0.001), with the presence of left ventricular hypertrophy (p < 0.001), the development of concomitant type 2 DM (p ≤ 0.001). It should be noted that in contrast to BMI, higher rates of PBF, BFM and FMI were more likely to correlate with older age, history of smoking and excessive alcohol consumption as well as the presence of concomitant thyroid pathology. Assessment of the lipid profile showed a significant correlation between BMI, BFM, FMI and the level of triglycerides (TG), very low­density lipoprotein cholesterol and with high­density lipoprotein cholesterol (HDL­C). The presence of visceral obesity was strongly correlated with triglyceride­glucose index (TyG index) (p ≤ 0,001). According to the results of the factor analysis, the severity of AH in the examined patients is primarily due to metabolic disorders associated with disorders of lipid metabolism and the development of varying degrees of insulin resistance, which in male is most strongly correlated with TG levels (r = 0.899), atherogenic index of plasma (r = 0.872), TyG index (r = 0.788), in female — with HDL­C (r = –0.770), atherogenic coefficient (r = 0.768), TG (r = 0.749). In contrast to the population of female, for male with AH there is the additional most important component of the indicators was estimated that characterizes the presence of comorbid chronic diseases of the pancreas (r = 0.754) on the background of a history of alcohol abuse (r = 0.627) and/or comorbid non­alcoholic fatty liver disease (r = 0.558). Conclusions. The severity of GC in the examined patients is primarily due to metabolic disorders associated with disorders of lipid metabolism and the development of varying degrees of insulin resistance on the background of visceral obesity.