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Shalimova Cardiovascular remodeling in EH and DM2

INTRODUCTION in patients with EH and concomitant DM2 according
to the genetic polymorphisms of AGTR1 and PPARγ2.
There are a large number of patients with essential
hypertension (EH) who also have type 2 diabetes METHODS
mellitus (DM2), thus meriting further research into
this problem. It is known that EH and DM2 have The authors examined 320 patients with EH stage II
many common pathogenetic mechanisms that affect grade 2 and moderate, sub-compensated DM2 (the
the development of comorbidity. According to many main group); 90 patients with EH stage II grade 2
researchers, the most important predictors of EH and without DM2 (the comparison group); and 31 healthy
DM2 are hereditary risk factors. [1-3] However, there are individuals (the control group).
controversial views on the role of gene expression and
genetic polymorphisms in the development and course In this study, using standard biochemical methods
of diseases in different populations of patients, as well on the patients, we defined venous blood glucose
as their influence on the effectiveness of drug therapy. concentration, glycosylated hemoglobin (HbA1c),
and insulin levels. IR was determined using the
Some studies have shown that the predisposing cause homeostasis model assessment index (HOMA-IR).
of EH can be mutational alleles of the angiotensin II Ultrasound examinations were performed on a cardiac
receptor (AGTR1) gene; angiotensin is a powerful ultrasound scanner («ULTIMA RA» firm “RADMІR”,
vasoconstrictor, thus playing a role in the pathogenesis Ukraine) in one-, two-dimensional and Doppler modes
of EH. [4,5] Angiotensin II (АТ-ІІ) receptor type 1, which is with color mapping by conventional methods. The
located on the vascular endothelium, mediates the main following measurements were made: volumes of the
cardiovascular effects of angiotensin, including the left atrium (LА) and right atrium (RA); end-systolic
induction of insulin-like growth factor and endothelin-1. diameter (ESD) and end-diastolic diameter (EDD) of
The induction of cell growth is also mediated through the left ventricle (LV); end-diastolic pressure (EDP)
AGTR1. A number of investigations have reported in the LV; left ventricular ejection fraction (EF); index
[6]
that AGTR1 polymorphisms may lead to changes in of relative wall thickness (IRWT); and the myocardial
the regulation of vascular tone and proliferation of mass index (MMI) of the LV. Diastolic function of the
vascular wall elements. [7] LV was assessed by studying the blood flow in the
pulmonary artery and transmitral diastolic flow in the
Hyperinsulinemia and insulin resistance (IR) are the pulsed Doppler mode with the following parameters:
factors that determine the frequency of cardiovascular maximum rate of early LV filling (E); maximum speed
complications in DM2. [8-10] Despite the fact that IR has a of late (atrial) LV filling (A); the ratio of the maximum
clearly identified genetic predisposition, its underlying velocity of early and late LV filling (E/A); LV isovolumic
genetic disorders have still not been identified.
relaxation time (IVRT); deceleration time (DT) of early
There has been extensive research into the diastolic flow velocity; average pulmonary artery
polymorphisms of peroxisome proliferator-activated pressure (PAP), according to Kitabatake; the ratio of
receptors (PPAR), which are transcription factors that peak E and e on the mitral valve in the spectral and tissue
control the activity of many genes, as well as regulating Doppler (E/e). For studying endothelial function, the
lipid and carbohydrate metabolism. [11,12] Here we degree of endothelium-dependent vasodilation (EDVD)
focused on PPARγ2, which is almost exclusively in reactive hyperemia was determined in all patients.
located in adipose tissue, and plays a vital role in Investigations were carried out using a broadband
controlling adipogenesis and circulation of fatty acids. linear transducer 5-12 MHz Doppler color mapping
with three readings being taken arteries at 15-min
It has been established that genetic polymorphisms of intervals between samples on the left and right brachial
PPARγ2 are different in diverse populations, and data arteries, according to the method of Celermajer DS (a
on the effect of PPARγ2 on the development of IR are modification of the method by Ivanova OV). Normally,
quite controversial. Therefore, there is a continued the maximum vasodilation of the brachial artery should
interest by scientists into the study of PPARγ2 exceed 10% of the original diameter. Simultaneously,
polymorphisms in the development of IR and other we measured the intima media thickness (IMT) of the
pathological processes, and the presence of conflicting carotid artery (CA 2 cm proximal to the bifurcation
data regarding its role in different populations justifies of the common carotid artery). Pulse wave velocity
the ongoing research into the Ukrainian population of (PWV) of the CA was determined using the W-Track-
patients with comorbid disorders. method (method of phase tracking, patented scanner
developers). Determining the PWV of the abdominal
Our aim was to study heart and vascular remodeling aortic (AA) (on the left subclavian artery to the femoral
Vessel Plus ¦ Volume 1 ¦ June 27, 2017 85