Objective: of article was to study the level of cerebral natriuretic peptide in patients with type 2 diabetes mellitus with diastolic dysfunction and with various types of left ventricular remodeling. Materials and methods: 256 patients with type 2 diabetes mellitus (DM) who had moderate arterial hypertension (AH) and no clinical signs of chronic heart failure were examined. The control group consisted of 30 practically healthy persons, comparable in age and sex with the examined patients. All patients were determined the concentration of brain natriuretic peptide (BNP) in blood plasma. The structural and functional parameters of the heart were determined by echocardiography in B- and M-modes according to the standard technique. Results: in patients with type 2 diabetes and diastolic dysfunction, the BNP concentration was 156 (84; 228) pg / ml, in patients without diastolic filling disorders — 24 (12; 38) pg / ml. The highest BNP values were found in the subgroup of patients with a restrictive type of transmitral flow. Also, BNP values were higher in the group of patients with concentric and eccentric left ventricular (LV) hypertrophy. Conclusion: in all patients with type 2 diabetes and concomitant moderate hypertension, even in the absence of clinical signs of CHF, there is an increase in the BNP level compared to the control group. The highest BNP values were observed in patients with severe diastolic dysfunction and unfavorable variants of LV remodeling.

Secondary cardiorenal syndrome (CRS) in patients with type 2 diabetes is a combined cardiac and renal pathology with a combined and complex not fully understood pathogenesis, quickly leads to the death of the underlying disease. In this case, a violation of the function of one organ affects the functional state of another, and vice versa. An important role in the CRS pathogenesis is played renin-angiotensin-aldosterone system activation, leading to the progression of cardiac and renal hemodynamic disorders. The aim was to study the parameters of intrarenal hemodynamics and their relationship with the level of aldosterone and natriuretic peptide in patients with secondary cardiorenal syndrome in type 2 diabetes mellitus. In the course of the study, 48 patients with type 2 diabetes and secondary CRS were examined. There were 24 men and 24 women. The average age of the examined patients was 60.3 ± 7.5 years. The duration of type 2 diabetes in patients was 9.53±2.82 years. The control group consisted of 40 practically healthy volunteers matched by sex and age. The formation of secondary CRS in type 2 diabetes is accompanied by an increase concentrations of the N-terminal cerebral natriuretic propeptide (p <0.001) and aldosterone (p <0.001), the development of renal vascular remodeling and a decrease hemodynamic renal parameters. In patients with CRS and type 2 diabetes the presence of negative correlations between the level of aldosterone and the velocity indices of blood flow in the kidneys and a positive relationship with the indices of resistance of the renal arteries was found, as well as positive relationships between the level of NT-proBNP and indices of resistance in the vessels, negative - with speed indicators. In the course of multiple regression analysis, the influence of NT-proBNP and aldosterone levels on the predicted values of the peak velocity in the interlobular arteries (R2 = 0.30), glomerular filtration rate (R2 = 0.48) was established.

Patients with type 2 diabetes mellitus (DM) have a high risk of secondary cardiorenal syndrome, which increases the death rate in these patients. Diabetes-associated heart and kidney damage is an important and largely underestimated cause of global morbidity and mortality. The research for new combinations of cardionephroprotective drugs is currently an urgent task. The aim of this study was to evaluate the effectiveness of the combination of valsartan and amlodipine versus the combination of sacubitril/valsartan and amlodipine in relation to cardiac and nephroprotection in patients with type 2 diabetes mellitus. The study involved 96 patients with type 2 diabetes with secondary cardiorenal syndrome. There were 54 (56.25%) men and 42 (43.75%) women. The average age was 60.27±7.53 years. During the study, patients were randomized into two groups. Group 1 (n=48) consisted of patients with type 2 diabetes with age 59.38±7.74 years who received a combination of valsartan and amlodipine for 6 months. Group 2 (n=48) consisted of patients with type 2 diabetes with age 61.17±7.29 years who received therapy which consisted of sacubitrile/valsartan and amlodipine for the same time. The control group consisted of 40 practically healthy volunteers whose average age was 60.3 ± 7.0 years. It was revealed that cardiac markers NT-proBNP, cystatin C, aldosterone are integral indicators of the risk of developing cardiovascular and renal dysfunctions, and increases in patients with type 2 diabetes indicates a high probability of progression of secondary cardiorenal syndrome. A six-month therapy with a combination of antihypertensive drugs valsartan with amlodipine and sacubitrile/valsartan with amlodipine in patients with type 2 diabetes equally effectively reduces blood pressure, while NT-proBNP and cystatin C significantly decrease against the background of an increase in glomerular filtration rate. In patients with secondary cardiorenal syndrome who received a combination of sacubitril/valsartan and amlodipine there was a more pronounced dynamics of a decrease in albuminuria and aldosterone levels.

INTRODUCTION. The data obtained in clinical studies of recent years of the possible inhibitors of sodium-glucose cotransporter type 2 (SGLT2) nephroprotective effect in type 2 diabetes mellitus necessitate the further study of these drug's effect on kidney injury risk factors.THE AIM: to study the effect of SGLT2 inhibitor empagliflozin as part of combination therapy on the main mechanisms of kidney damage in patients with type 2 diabetes.PATIENTS AND METHODS. We have completed a clinical randomized study in parallel groups in patients with type 2 diabetes of nephroprotective effects of SGLT2 inhibitor empagliflozin during 2 years. The study included 244 patients with type 2 diabetes with a preserved glomerular filtration rate (GFR) and moderate arterial hypertension (AH), who had previously taken perindopril and indapamide, but did not reach target blood pressure (BP) values. Patients were randomized into 2 groups: Group I (n = 120) took Perindopril 10 mg per day, Indapamide retard 1.5 mg per day, β-blocker Carvedilol 12.5-25 mg 2 times a day; Group II (n = 124) was additionally prescribed empagliflozin 25 mg per day. The study endpoints were GFR changes, albuminuria, and renal blood flow as measured by Doppler imaging. Also studied the dynamics of blood pressure and glycemic control.RESULTS. It was found that empagliflozin as part of complex therapy for type 2 diabetes is able to reduce albuminuria and prevent a decrease in GFR within a 2-year follow-up period. The use of empagliflozin promoted an increase in the rate of renal blood flow and a decrease in intrarenal vascular resistance and had a corrective effect on the daily dynamics of blood pressure and glycemic control.CONCLUSION. Empagliflozin improves intrarenal and systemic hemodynamics, prevents a decrease in GFR, reduces albuminuria, and improves glycemic control in type 2 diabetes.