Aim. To determine the value of concomitant non-alcoholic fatty liver disease in patients with arterial hypertension in the progression of rigidity of the main arteries and in increase of risk of cardiovascular complications. Material and methods. A cross-sectional comparative study was conducted. Group 1 (n=50, 35(70%) women, average age 57,4±6,9 years) included patients with arterial hypertension and non-alcoholic fatty liver disease, group 2 (n=50, 40(80%) women, average age 56,5±7,0 years) included patients with arterial hypertension only. The groups were comparable in the main clinical and demographic indicators (p>0,05). A comparative analysis of pulse wave velocity, central aortic pressure, vascular age and a 10-year risk of developing cardiovascular complications in both groups was performed.Results. There is a statistically larger number of patients with metabolic index>7,0 (58,0% vs 28,0%, p=0,0019). It was also established that systolic (121,9±10,9 mm Hg vs 115,9±8,9 mm Hg) and diastolic (82,5±9,3 mm Hg vs 77,4±8,9 mm Hg) aortic pressure, as well as the augmentation index (26,5±8,5% vs 18,6±4,2%), were significantly higher in patients with arterial hypertension and non-alcoholic fatty liver disease than in patients with isolated arterial hypertension. In the 1st group, a statistically significant increased pulse wave velocity was found both in muscular (12,0±3,1 m/s vs 10,6±1,8 m/s) and elastic (10,4±2,8 m/s vs 9,1±1,7 m/s) vessels, which indicates an increase in arterial stiffness. In addition, there was an increase in post-occlusal pulse wave velocity in this category of patients (11,0±3,3 m/s vs 9,4±1,9 m/s, p=0,0037). A significant increase in vascular age in relation to the passport age (60,4 [56,0:68,0] years vs 58,0 [53,0:60,0] years) and an increase in the 10-year fatal risk was detected (2,15 [1,42: 4,63] and 1,05 [0,52: 2,82] %, p = 0,0043 ) were also revealed in patients with arterial hypertension and non-alcoholic fatty liver disease compared to patients with isolated arterial hypertension. Significantly more patients with a high (13 (26,0%) vs 5 (10,0%), p = 0,0332) total cardiovascular risk were observed in group 1 than in group 2.Conclusions. Arterial stiffness was significantly higher in patients with arterial hypertension and non-alcoholic fatty liver disease than in patients with isolated arterial hypertension, which is confirmed by a statistically significant increase in pulse wave velocity and central aortic pressure. Comorbid patients have pronounced endothelial dysfunction, which is confirmed by a significant increase in the post-occlusion rate of the pulse wave. An increase in vascular age in relation to the passport age indicates earlier aging of blood vessels in the 1st group compared with the 2nd group. Patients in the main group have a higher incidence of a high 10-year risk of developing cardiovascular events compared with patients in the control group.

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Many researchers attribute obesity to an independent risk factor for perioperative complications of off-pump coronary artery bypass grafting (off-pump CABG). AIM. To conduct a comparative analysis of the early postoperative complications of off-pump CABG in obesity patients with with various types of anesthetic benefits. MATERIALS AND METHODS. A randomized study of the results of surgical treatment was carried out in obesity patients with coronary heart disease performing pump CABG. The study included 197 patients. The study group (n = 98) included patients who underwent combined anesthesia (with thoracic epidural analgesia (TEA)), and patients in the control group (n = 99) underwent total intravenous anesthesia (with opioids). RESULTS. The use of combined anesthesia (with TEA) in patients with obesity significantly reduced the risk of developing new onset of renal dysfunction (p = 0.0180), respiratory complications (p = 0.0177), atrial and ventricular arrhythmias (p = 0.0029). We were less likely to diagnose other complications in patients of the study group, compared with patients in the control group: acute coronary syndrome (1.0% versus 3.0%, p = 0.3173), multiple organ failure syndrome (1.0% versus 3.0%, p = 0.3173), local infectious complications (1.0% versus 6.1%, p = 0.0561). An uncomplicated early postoperative period was observed in 89.8% of patients in the study group and in 52.5% of patients in the control group (p = 0.0000). CONCLUSION. The use of combined anesthesia (with TEA) for off-pump CABG in patients with obesity reduces the risk of early postoperative complications, duration of hospitalization and stay in an intensive care unit. K E Y w O R D S-off-pump coronary artery bypass grafting, prevention of complication, obesity, thoracic epidural analgesia.

Objective. To assess the effect of antihypertensive therapy with ramipril and indapamide on the elasticity of the vascular wall of the large arteries in relation to insulin resistance and chronic low-intensity inflammation in patients with hypertension (HTN) and non-alcoholic fatty liver disease (NAFLD). Design and methods. An open prospective controlled study was conducted: 30 patients with HTN stage I–II in combination with NAFLD (Fatty Liver Index (FLI) > 60) at the age of 45–65 years were included. Washout period was scheduled 5–7 days before the baseline examination, followed by the prescription of one of the fixed combinations of ramipril (2,5/5 mg/day) and indapamide (0,625/1,25 mg), depending on the required dosage (Konsilar-D 24 VERTEX AO, Russia) and were given recommendations on lifestyle changes and weight loss. A clinical examination was carried out, indicators of daily blood pressure (BP) monitoring and central aortic pressure (CAP), pulse wave velocity (PWV), lipid and carbohydrate metabolism, chronic low-intensity inflammation and the severity of insulin resistance before and after treatment were analyzed. Results. After 24-week therapy with a fixed combination of ramipril and indapamide at an average dosage of 4,04 ± 1,24 and 1,01 ± 0,31 mg, respectively, 100% of patients with HTN and NAFLD achieved target BP levels. According to 24-hour BP monitoring data, a significant decrease in systolic BP (SBP) and diastolic BP (DBP) was observed, both in the daytime (Δ12 mm Hg, р = 0,0001; Δ5,5 mm Hg, р = 0,0019, respectively), and at night (Δ13,5 mm Hg, р = 0,0006; Δ5,5 mm Hg, р = 0,0054, respectively). In addition, there was a significant decrease in CAP in the daytime (SBPao p = 0,0011, DBPao p = 0,0022) and night hours (SBPao p = 0,0015, DBPao p = 0,00124), and a statistically significant decrease in augmentation index (day p = 0,0460, night p = 0,0182). When evaluating clinical data and bioimpedance measurements, a decrease in waist circumference (p = 0,0000), hip circumference (p = 0,0001), the proportion of subcutaneous (p = 0,0134) and visceral (p = 0,0019) fat was found, which may indicate a decrease in the severity of visceral obesity. Also, during treatment, there is a decrease in the severity of insulin resistance (and the concentration of tumor necrosis factor alpha (TNF-α) (p < 0,0001) and CRP (p = 0,0002) in blood plasma. Finally, fixed combination of ramipril and indapamide led to a significant decrease in vascular stiffness (p = 0,0166) and a decrease in the proportion of patients with PWV paradoxical test (p = 0,0320). Correlation analysis showed that increased stiffness of the large arteries in patients with HTN and NAFLD is closely related to insulin resistance and lipid metabolism. At the same time, after 24-week therapy by a fixed combination of ramipril and indapamide, a decrease in the vascular stiffness in patients with HTN and NAFLD significantly correlated with the TNF-α concentration. Conclusions. A 24-week therapy by the fixed combination of ramipril and indapamide iin patients with HTN and NAFLD is associated with the persistent decrease in BP and CAP, both during the day and at night. There was a decrease in the vascular rigidity in muscular arteries. The treatment and recommendations for changing the lifestyle are associated with the decrease in the severity of abdominal obesity and insulin resistance, as well as the decrease in the severity of low-intensity systemic inflammation in patients with HTN and NAFLD, and a significant correlation was established between a decrease in TNF-α and an increase in the vascular elasticity of muscle and elastic type arteries.