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0и старше по данным ВОЗ). Мы не выявили очаговых или диффузных поражений паренхимы щитовидной железы у всех обследованных.
Заключение
Таким образом, полученные результаты позволяют сделать предварительный вывод о том, что у молодых женщин с синдромом дисплазии соединительной ткани отсутствуют клинически значимые нарушения углеводного обмена, гормонального и тиреоидного статуса. По результатам ультразвукового исследования не было выявлено очаговых или диффузных изменений паренхимы щитовидной железы. Тем не менее, у 10% обследованных пациенток было выявлено незначительное повышение уровня тиреотропного гормона, которое, вероятно, следует расценивать как проявление субклинического гипотиреоза. Это, в свою очередь, диктует необходимость дальнейшего углубленного изучения тиреоидного обмена у данной категории пациентов. По нашему мнению, необходимо определение гормонального статуса у всех женщин детородного возраста с недифференцированной дисплазией соединительной ткани, с учетом доказанной роли последней в формировании женского бесплодия.
Список литературы
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INTERCOURSE OF THE DAILY RHYTHM OF ARTERIAL PRESSURE WITH OVERWEIGHT BODY MASSAGE IN PATIENTS WITH ARTERIAL HYPERTENSION AND OSTEOARTHROSIS
Shvets V.,
Professor ofphysiology department, Doctor of biological science, Higher State Educational Establishment
of Ukraine «Bukovinian State Medical University», Chernivtsi (Ukraine)
Shvets N.
PhD of medical science, Higher State Educational Establishment of Ukraine "Bukovinian State Medical University", Chernivtsi
Abstract
An important factor in combining osteoarthritis and arterial hypertension is that the treatment of the first disease in many cases leads to the progression of another. And in the presence of excess body weight, hormones and cytokines, which form an adipose tissue, interact at the level of neuronal systems, causing hyperactivation of sympathetic activity, an increase in the level of arterial pressure. Daily monitoring of blood pressure is the only non-invasive method of blood pressure over the course of the day. Consequently, in patients with a combined course of arterial hypertension and osteoarthritis, a more significant increase in the mean daily blood pressure values is observed, which may be due to a number of causes. On the basis of analysis of changes in the indicators of daily blood pressure monitoring, it was found that with a comorbid flow of arterial hypertension and osteoar-thritis, significantly higher average daily values of systolic blood pressure and diastolic blood pressure are registered, its variation increases, with all of these changes progressing with an increase in the body mass index.
Keywords: arterial hypertension, obesity, osteoarthritis, daily monitoring of blood pressure, body mass index.
Introduction. An important factor in the combination of osteoarthritis (OA) and arterial hypertension (AG) is that treatment of the first disease in many cases results in the progression of another. Thus, it has been shown that the majority of nonselective NSAIDs
(NSAIDs) are capable of causing an increase in blood pressure due to a violation of the synthesis of a natural vasolitatin - prostacyclin - in daylight hours [4, 18]. In contrast, the selective representatives of the group -rofecoxib, nabumeton - did not cause significant
changes in blood pressure in daylight, however, caused a significant increase at night, which led to the leveling of the physiological daily variation [1, 20]. An increased risk of developing myocardial infarction was also observed in patients taking selective inhibitors of cyclooxygenase-2 (celecoxib) and some non-selective NSAIDs (ibuprofen, diclofenac) [8]. For excess body weight, hormones and cytokines, which form fatty tissue, interact at the level of neuronal systems, causing hyperactivation of sympathetic activity, increase in the level of arterial pressure. The positive correlation is confirmed for leptin, and the negative for adiponectin [7, 16, 26]. Daily blood pressure monitoring (DMAT) during the day and longer can vykorystovuvatsya not only for diagnosis and monitoring the effectiveness of treatment of hypertension, but also to study the effects on blood pressure of different stress, diet, alcohol, smoking, physical activity, concomitant drug therapy and available comorbid pathology [2]. This is the only non-invasive method of examination that allows you to: get information about the level and fluctuations of blood pressure during the day, during sleep and waking; to identify patients with nocturnal hypertension, in which there is an increased risk of damage to target organs [4]; to assess the adequacy of lowering blood pressure between doses of regular doses of medicinal product [3]; to control the absence of excessive reduction of blood pressure at the peak of the drug or insufficient reduction before the next dose [12]; Detect patients with low or high variability of blood pressure (insufficient or excessive decrease at night) [15] and to decide on the selection and appointment of a hypotensive drug [9].
The aim of the study. Thus, it was interesting to trace how the daily rhythm of blood pressure changes
in patients with hypertension and OA depending on the presence of excess body weight.
Materials and methods. Thus, in order to study the features of daily changes in blood pressure in conditions of combined flow of hypertension and OA depending on the presence of excess body weight, we analyzed the results of DMAT, which was performed for 65 patients with isolated AG (group I, n = 35) and hypertension associated with OA (group II, n = 30). Depending on the size of the BMI, the patients in both groups were divided into two subgroups: IA (n = 17) and IIA (n-18) - persons with BMI <25 kg / m2; IB (n = 15) and IIB (n = 15) - patients with BMI> 25 kg / m2.
Research results and their discussion. A group analysis of DMAT results in patients with hypertension and OA showed that the average daily systolic blood pressure (SAT) was significantly higher in patients in group II (161.34±5.24 mm Hg) compared with group I (148.26±3.82) mm Hg, p <0.05). A similar pattern was noted for the values of daily diastolic blood pressure (DAT). Thus, in patients of group I this index was 86,44±2,72 mm Hg. at the time when it was 95.18±3.15 mm Hg in group II) (p <0.05), as shown in Figure 1.
Thus, in patients with combined hypertension and OA there is a more significant increase in the average daily values of blood pressure, which may be due to a number of reasons. Prolonged use of NSAIDs in patients with a combination of rheumatic pathology is considered to have a negative effect on the kidneys [17, 27]. Thus, diclofenac primarily affects the renal blood flow and glomerular filtration velocity, while coxib may possibly adversely affect the electrolyte-water metabolism in the kidneys [31, 33]. And this, in turn, triggers irreversible processes that lead to a violation of the renin-angiotensin-aldosterone regulation of AT [9, 13].
(Likelihood of difference: * - between groups) Fig. 1. Indicators of systolic blood pressure and diastolic blood pressure in patients with arterial hypertension that occurs in isolation and in combination with osteoarthritis.
AG in obesity occurs six times more often. An increase in body weight by 10% leads to an increase in blood pressure by an average of 6/4 mm Hg. Weight loss in patients with obesity leads to a moderate decrease in blood pressure [11]. Our analysis of the average daily values of SAT and DAT in the patients of both
groups, depending on the BMI, showed that within the groups there is an increase in average daily values of blood pressure with the increase of BMI. Thus, in the surveyed persons with BMI <25 kg / m2, the average daily values of SAT were 153.62 + 4.38 mm Hg, and
DAT - 87.31 + 2.93 mm Hg; while in patients with subgroups IB and IB, the values of both indicators were significantly higher: 168.24 + 5.71 mm Hg. (p <0.05) for SAT and 96.89 + 3.74 mm Hg (p <0,05) for DAT. At the next stage of the study, we analyzed the changes in the standard deviation (SD) of the SAT and DAT as an indicator that characterizes the diurnal variability of blood pressure. According to the results of the DMAT measurements, the values of SV CAT were significantly higher in patients with hypertension and OA (group II) - 18,38±0,68%, compared to patients with isolated AG (group I) - 15,32±0,37 %, (p <0.01). A similar pattern was found for the JI DAT index, it was significantly increased with joining the AG of OA -15,34±0,36% compared with patients with isolated AG - 13,51±0,29%, p <0,01. Thus, in patients with a comor-bidity of hypertension and OA, daily diurnal variations in SAT and DAT are likely to increase significantly, which significantly worsens the prognosis in this category of patients, since according to a number of studies, an increase in daily blood pressure variability results in more frequent complications such as myocardial infarction and a stroke, and the risk of complications from the cardiovascular system increases with the increase of BMI [15]. Daily oscillations of blood pressure are one of the major determinants of target organ damage, therefore, in medical correction of blood pressure should not only reduce the blood pressure, but also try to reduce its variability, which should serve as one of the criteria for choosing antihypertensive therapy [12]. Analysis of daily diarrhea of blood pressure in patients with isolated AG and when combined with OA showed that the daily rhythm of blood pressure in patients of group I has two distinct peaks of blood pressure: in the morning - from 6 to 9 in the morning and in the afternoon - from 17 to 19 hours and the plateau - in the interval from 9 to 17 hours. Patients in this group are characterized by a decrease in blood pressure indices in the evening hours to the minimum values at night, due to the physiological activity of the neuro-humoral regulatory systems of the body, although there is some flattening of the daily blood curve compared with the norm.
Conclusions. Based on the analysis of changes in the indicators of DMAT, it was found that during the comorbid flow of AG and OA, significantly higher average daily values of SAT and DAT are recorded, and the variability of AT increases, with all of these changes progressing with an increase in BMI. Prospects for further research: Perspective is the study of long-
term results of the study, as well as lipid metabolism, proteinuria, microalbuminuria in patients with arterial hypertension combined with osteoarthritis in the background of elevated body mass index and when BMI is normal.
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