No abstract

Recent studies have shown that heart disease in patients with rheumatoid arthritis occurs according to various data in 20-100% of cases. Hypertension is often the first objectively detectable marker of cardiovascular pathology in patients with rheumatoid arthritis. Hypertension in patients with rheumatoid arthritis usually becomes an active initiator and accelerator of the progression of atherosclerosis and remodeling of the left ventricle. Cardiac remodeling in patients with hypertension and in patients with rheumatoid arthritis, combined with hypertension is a significant factor that affects to the quality of life and prognosis and requires careful study of this problem. The purpose of the work was to study the systolic function and morphological parameters of the left ventricle in patients with rheumatoid arthritis in combination with hypertension and to establish indicators associated with high cardiovascular risk. Material and methods. The main group of patients consisted of 93 patients with rheumatoid arthritis of moderate activity in combination with hypertension stage II. The second group included 45 patients with essential hypertension stage II. The control group had 31 almost healthy people. An ultrasound examination of the heart was performed with studying of systolic function and the main morphological parameters of the left ventricle. Results and discussion. We found a significant increase in the left ventricle myocardial mass index by 11.97% in patients with rheumatoid arthritis in combination with hypertension compared to the patients with essential hypertension and by 30.1% compared to the control group. We also detected the significant increase of the interventricular septum thickness by 9.02%, the posterior wall of left ventricle – by 5.51%, and the relative wall thickness of left ventricle – by 6.0% in patients with rheumatoid arthritis in combination with hypertension compared to the patient with essential hypertension. There was a significant increase in end-diastolic volume by 8.64%; end-systolic volume – by 12.95%; and a decrease of ejection fraction by 2.5% in patients with rheumatoid arthritis in combination with hypertension with m SCORE >4 points compared to the corresponding indicators of patients with m SCORE ≤4 points. The study showed that the most common type of left ventricle remodeling was concentric left ventricle hypertrophy (79% of patients) in patients with rheumatoid arthritis with hypertension. In addition, the subgroup of patients with m SCORE >4 points left ventricle myocardial mass and left ventricle myocardial mass index were by 15.01% and 14.86% significantly higher than the corresponding indicators in the subgroup of patients with m SCORE ≤4 points. Conclusion. The patients with rheumatoid arthritis in combination with hypertension showed an association between increasing of the left atrium size and the volume parameters of the left ventricle, and the presence of fluid in the pericardial cavity. This was manifested by the left atrium size increase by 10.65%, end-diastolic volume – by 8.62%, end-systolic volume – by 12.2% and the ejection fraction decrease by 2.23% in patients with fluid versus to a subgroup of patients without fluid in the pericardium

LIPID PROFILE IN COMPREHENSIVE TREATMENT OF CARDIOVASCULAR EVENT OF PATIENTS WITH RHEUMATOID ARTHRITIS

Hypertensive disease is one of the most common diseases in the world and the leading cause of death and disability from cardiovascular diseases among the population. Recent studies have indicated that patients with hypertension in combination with rheumatoid arthritis have a higher risk of cardiovascular complications and mortality. Ukrainian recommendations for the management of patients with hypertension for 2018 indicated that angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are more effective in regressing left ventricular hypertrophy. The purpose of the study was to compare the effect of long-term therapy with valsartan in combination with indopamide and amlodipine on the structural and functional state of the left ventricular myocardium and the level of blood pressure in patients with arterial hypertension in combination with rheumatoid arthritis. Material and methods. The study included hypertensive patients in combination with rheumatoid arthritis. The patients were divided into 3 groups: the first group consisted of 17 patients with essential hypertension in combination with rheumatoid arthritis who took valsartan at a dose of 80 mg at home. The second group included 17 patients who were transferred to additional administration of the drug indapamide at a dose of 15 mg. The third group consisted of 18 patients whose dose of amlodipine was increased from 5 to 10 mg Results and discussion. In the daily blood pressure profile, the time-averaged values of systolic blood pressure and diastolic blood pressure were calculated for three-time intervals of 24 hours, day and night. Left ventricular remodeling was assessed by the relative left ventricular thickness - the ratio of the sum of the thickness of the interventricular septum and the thickness of the posterior wall to the final diastolic size of the left ventricular. The norms were considered to be an indicator of relative wall thickness <0.45. When studying the analysis of the effect of 4-week monotherapy of valsartan at a dose of 80 mg / day on the level of blood pressure and daily blood pressure profile, we revealed a statistically significant decrease in blood pressure by -14.1±2.2 / -8.2±1.4 mm Hg. Art. (P <0.01), mean daily values of systolic blood pressure (24) by 15.1±2.4 mm Hg. Art. (P <0.001), diastolic blood pressure (24) on September 8±1.7 mm Hg. Art. (P <0.001), day and night mean values and indicators of systolic blood pressure and diastolic blood pressure. Analysis of 24-week monotherapy with amlodipine (the average dose of which was 10 mg / day) in 15 patients revealed a decrease in blood pressure by 24.1±3.6 / 15.2±2.3 mm Hg. Art. (P <0.01) and its normalization in 9 out of 15 patients (60%). According to the ABPM data, a significant decrease in systolic blood pressure and diastolic blood pressure was revealed within 24 hours, both in the daytime and at night. The target level of 24-hour AO was achieved in 6 (40%) patients. Valsartan therapy and their combination with indapamide led to regression of left ventricular hypertrophy in all patients, normalization of left ventricular geometry in 33% of patients. In 24 patients with concentric left ventricular hypertrophy, in (25%) left ventricular myocardial mass index and left ventricular geometry normalized, in 4 (17%) patients, left ventricular hypertrophy became eccentric, in 1 (4%) it turned into concentric remodeling, in 10 (54%) patients it remained without changes. Conclusion. Therefore, valsartan and its combination with indapamide in these patients led to regression of left ventricular hypertrophy, normalization of left ventricular geometry in 33% of patients, improvement of left ventricular diastolic function in 88.2%