THE ROLE OF NEUROHORMONAL FACTORS - GALECTIN-3 AND ALDOSTERONE IN THE FORMATION OF THE CLINICAL PROFILE OF THE PATIENT AND THE INFLUENCE ON THE STRUCTURAL REMODELING OF THE HEART AND VESSELS IN PATIENTS WITH HYPERTONIC DISEASE
The article is devoted to the study of the urgent problem of modern cardiology with regard to improving the prediction of the course of Essential arterial hypertension (AH), stage II, in patients of young and middle age based on the study of the role of age-related and neurohumoral factors - galectin-3 and aldosterone in the formation of the clinical profile and structural remodeling of the heart and vessels.
The study was conducted according to the protocol of the current clinical and performed at the Department of Therapeutic Disciplines and Family Medicine of the Faculty of Postgraduate Education, Vinnytsya National Pirogov Memorial Medical University. The material was collected on the basis of the Khmelnytsky Regional Cardiovascular Center of the Khmelnytsky Regional Council in the period from January 2016 to April 2017.
Patients with hypertension, who participated in the study, were divided into 4 groups depending on age: groups of young and middle age. The group of young patients included men and women (40 people), aged 18 to 44 years. The middle-aged groups included men and women (40 people), aged 45 to 60 years. The total number of the examined patients which we surveyed and were included in the study was 160 persons. The control group included 27 relatively healthy persons (male and female). The average age and the percentage of young and middle-aged patients did not differ significantly. Verification of the diagnosis of hypertension was carried out on the basis of the existing criteria and recommendations.
In the course of study, all the patients have undergone laboratory tests (determination of the level of galectin-3 and aldosterone, glucose, creatinine, electrolytes (Na 2+, K +), total cholesterol, triglycerides, high, low and ultra-low density lipoprotein cholesterol), instrumental tests (electrocardiography (ECG ) in 12 leads, 24-hour ambulatory blood pressure monitoring (ABPM), echocardiographic (Echo CG) in M, B-, D modes, the structural state of the carotid arteries (CA) based on the assessment of the thickness of the intima-media (TIM) and statistical studies.
Aldosterone level was determined by the enzyme-linked immunosorbent assay ELISA using reagents of IBL International GmbH (Canada). Aldosterone level of 40-160 pg/ml was considered as the reference values.
The level of galectin-3 in serum was determined by the solid-phase enzyme linked immunosorbent assay using a set of reagents of Human Galectin-3 Platinum Elisa (Bender MedSystems GmbH, Austria).
Scores reflect the prognostic value of indicators. The most valuable for predicting relatively high levels of galectin-3 are obesity, carotid artery Intima Media > 0.91 mm and left atrial volume index > 34 ml/m2 (echocardiography), while aldosterone is obesity, the presence of a non-dipper profile according to аverage blood pressure (24 hour blood pressure monitoring) > 32 ml/m2 (еchocardiography) and nightly average heart rate > 62 (24 hour blood pressure monitoring).
When determining the IV level of galectin-3 and/or aldosterone, a more severe course of hypertension should be envisaged, and the patient should be referred to the group of high risk of complications from the heart and blood vessels and, possibly, an earlier indication of mineralocorticoids should be considered.
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