Pathogenetic features of the combined course of arterial hypertension and diabetes mellitus 2 type

Біловол, Олександр Миколайович; Бобронникова, Леся Романовна; Al-Trawneh, O. V.

doi:10.15407/internalmed2017.01.004

Cited by 2 publications

(1 citation statement)

References 38 publications

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“…That is why there is a need to clarify the diagnostic significance of allelic polymorphism of the BNP gene (locus T-381C-SNPrs 198389) in left ventricular hypertrophy (LVH) and the detection of early signs of CHF. This clarification seems especially important in patients with T2D, because it is proved that the violation of the regulation of the NP system is a significant factor not only in the initiation and progression of myocardial dysfunction, but also energy imbalance [6,33,39].…”

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confidence: 99%

Features of hemodynamics in the comorbid course of essential hypertension and type 2 diabetes in men, residents of Podillia, carriers of polymorphic variants of the brain natriuretic peptide gene

et al. 2020

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Essential hypertension (EH) and type 2 diabetes (T2D) are important risk factors for the development of chronic heart failure (CHF). The early detection of CHF, especially under comorbidity, remains a challenge. To solve it in today’s conditions are used not only instrumental diagnostic methods (Echo-CG), but also the assessment of plasma levels of biomarker – brain natriuretic peptide (BNP), the expression of which is determined by the corresponding gene (locus T-381C) and may depend on its structural organization. It is proved that deregulation of the natriuretic peptide system (NP) is an important factor in the initiation and progression of myocardial dysfunction and energy imbalance, but the role of genetic preconditions for these disorders, including the peculiarities of polymorphic variants of the most physiologically significant gene is still not enough clear. The aim of the work was to investigate the presence of associations between indicators of systemic and intracardiac hemodynamic and the carrier of polymorphic variants of the BNP gene (T-381C) in men, residents of Podillia with the comorbid course of EH 2 and type 2 diabetes mellitus. We examined 132 middle-age men: 62 patients with EH 2 and chronic heart failure (CHF) 0-I functional classes (FC) according to NYHA Classification and 70 - with EH 2 combined with T2D and CHF FC I-II. Patients with EH 2 included in the first group and patients with EH 2 and T2D included in the second group of comparison. Parameters of intracardiac hemodynamics were determined on the basis of pulsed Doppler echocardiography. The genomic DNA of the BNP gene (T-381C) for the determination of its alleles was isolated by PCR. The mathematical processing was performed using the standard statistical package Statistica 10. We calculated the primary statistical indicators, identified differences between groups on statistical signs, performed correlation and discriminant analysis. The calculation of the relative risk with a 95% confidence interval was performed using an online calculator (https://medstatistic.ru/calculators/calcrisk.html). Among men living in Podillya with EH, both in the presence and absence of diabetes mellitus 2, the T381C genotype of the BNP gene (p>0.05) dominates. In the group of comorbid patients diastolic dysfunction of the left ventricle (DD LV) was diagnosed in 90% of people (n=63), while in the isolated course of EH it was found only in 43.55% (n=28). Although among homozygotes T381T BNP gene its symptoms were 100% (n=24), and among carriers of the C allele – in 84.78% (n=39) of patients. Carriers of the T381T genotype of the BNP gene dominated among persons with DD grade II: 41.66% against 10.87% of carriers of the C allele (p<0.05), while among persons with DD LV grade I there were more carriers of the C allele. Homozygous T381T genotype with EH 2 and T2D had a higher level of pulse blood pressure (p<0,01), a higher probability of developing eccentric left ventricular hypertrophy (p≤0.05) and more pronounced diastolic changes in the myocardium, as compared with carriers of the C allele and can be allocated to the priority group of observation for the organization of targeted measures aimed at preventing the development and progression of CHF.

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Section: Introductionmentioning

confidence: 99%

Features of hemodynamics in the comorbid course of essential hypertension and type 2 diabetes in men, residents of Podillia, carriers of polymorphic variants of the brain natriuretic peptide gene

et al. 2020

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Features of development of diastolic heart dysfunction in patients with comorbid pathology depending on the functional state of the kidney

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Kirienko

et al. 2020

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The development of complications of diabetes mellitus and hypertension, in particular kidney and heart damage, mutually reinforcing each other, not only affect the quality of life, but also significantly reduce its average duration. One of the common problems in patients with comorbid pathology is the high prevalence of chronic heart failure. Very often chronic heart failure develops with a preserved left ventricular ejection fraction. These changes are associated with the diastolic phase of the heartbeat - diastolic dysfunction. The features of the development of diastolic dysfunction in patients with type 2 diabetes in combination with hypertension depending on the functional state of the kidneys were studied. After the initial examination, depending on the functional state of the kidneys, all examined patients were divided into three groups: first group consists of 25 patients with type 2 diabetes without signs of nephropathy; second group consists of 23 patients with type 2 diabetes with normal glomerular filtration rate and albuminuria; third group consists of 20 patients with type 2 diabetes with decreased glomerular filtration rate and albuminuria. The control group consisted of 20 healthy patients. To study the state of the heart, transthoracic echocardiography was performed on a ULTIMA PA ultrasound machine (Radmir, Ukraine) with a sectoral phased transducer with a frequency range of 2-3 MHz, according to the standard technique according to the recommendations of the American Echocardiographie Society. The data obtained confirm the need for prevention, early diagnosis, clarification of mechanisms and adequate treatment of diastolic dysfunction in diabetic nephropathy patients even before the onset of renal failure. Structural changes in cardiomyocytes activate the processes of apoptosis, enhancing the production of extracellular matrix, and contribute to the formation of myocardial fibrosis. Fibrous changes lead to the progression of impaired contractile function and an increase in the stiffness of the left ventricle walls, which leads to diastolic and systolic dysfunction and the development of heart failure. Diastolic myocardial function in diabetic nephropathy is complicated with the progression of the disease. Keywords: diabetes mellitus, hypertonic disease, diabetic nephropathy diastolic dysfunction, chronic kidney disease.

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Pathogenetic features of the combined course of arterial hypertension and diabetes mellitus 2 type

Cited by 2 publications

References 38 publications

Features of hemodynamics in the comorbid course of essential hypertension and type 2 diabetes in men, residents of Podillia, carriers of polymorphic variants of the brain natriuretic peptide gene

Features of hemodynamics in the comorbid course of essential hypertension and type 2 diabetes in men, residents of Podillia, carriers of polymorphic variants of the brain natriuretic peptide gene

Features of development of diastolic heart dysfunction in patients with comorbid pathology depending on the functional state of the kidney

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