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УДК 616.12-008.331.1+616.37 MODERN METHOD OF TREATMENT OF TYPE 2 DIABETES WITH ARTERIAL
HYPERTENSION Bektasheva Gulbahor Mahamadisak kizi
student of the 4th stage of the Faculty of Medicine Kholmatova Gulhayo Azimzhanovna
Senior Lecturer, Department of Hospital Therapy and Endocrinology Andijan State Medical Institute. islomionbektashev@gmail.com https://doi.org/10.5281/zenodo.7368497
Abstract. This article describes the modern treatment of type 2 diabetes in recent years and its effectiveness. Currently, modern and effective methods and drugs are being developed not only for the diagnosis of diabetes mellitus, but also for its treatment.
With the simultaneous manifestation of diabetes mellitus with arterial hypertension, it is important to fight this disease and take measures to simultaneously treat both competing diseases.
In patients with type 2 diabetes mellitus and arterial hypertension, the use of moxonidine and enalapril showed a more pronounced hypotensive effect compared to enalapril monotherapy, which was associated with a decrease in sympathetic-adrenal activity in this category of patients, and metabolic blood parameters also improved.
The article provides information on the effectiveness of certain drugs in the treatment of the disease, and this is the result of many years of research.
Keywords: moxonidine, enalapril, arterial hypertension, type 2 diabetes mellitus, cardiovascular disease, glucose, mean age.
СОВРЕМЕННЫЙ МЕТОД ЛЕЧЕНИЯ САХАРНОГО ДИАБЕТА 2 ТИПА С АРТЕРИАЛЬНОЙ ГИПЕРТОНИЕЙ
Аннотация. В данной статье рассказывается о современном лечении сахарного диабета 2 типа в последние годы и его эффективности. В настоящее время разрабатываются современные и эффективные методы и препараты не только для диагностики сахарного диабета, но и для его лечения.
При одновременном проявлении сахарного диабета с артериальной гипертензией важно вести борьбу с этим заболеванием и принимать меры для одновременного лечения обоих конкурирующих заболеваний.
У больных с сахарным диабетом 2 типа и артериальной гипертонией применение моксонидина и эналаприла показало более выраженный гипотензивный эффект по сравнению с монотерапией эналаприлом, которое было связано со снижением симпатико-адреналовой активности у данной категории больных, также улучшились метаболические показатели крови.
В статье представлена информация об эффективности некоторых препаратов при лечении заболевания, и это результат многолетних исследований.
Ключевые слова: моксонидин, эналаприл, артериальная гипертония, сахарный диабет 2 типа, сердечно-сосудистых заболеваний, Глюкоза, Средний возраст.
The number of patients with type 2 diabetes mellitus (DM) is increasing every year worldwide. A large number of studies have shown that type 2 diabetes mellitus (DM) is often
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2022 yil 30 noyabr | scientists.uz
associated with cardiovascular diseases, including arterial hypertension (AH). The development of DM and AH are interrelated diseases. For example, in a study by T.W. Gress et al (2000) showed that over 6 years of follow-up, the incidence of type 2 diabetes in patients with hypertension was more than 2 times higher than in normotensive patients. On the other hand, an increase in the level of glycemia is also associated with an increase in the risk of developing hypertension [1,2,3,5].
In large clinical trials, tight control of blood pressure has been shown to reduce the incidence of cardiovascular disease and mortality in people with type 2 diabetes [7]. Metabolic disorders of all types observed in DM, as well as dysregulation of the endocrine system, primarily significant changes in the level of contra-insular hormones, including catecholamines, are the causes of an increase in blood pressure (BP), which not only aggravates the course of DM, but also serves as an additional factor contributing to the deterioration of the function of the cardiovascular and other systems [5,8,10,11]. An effective drug used to treat arterial hypertension is moxonidine, a sympatholytic, an agonist of the imidazoline receptors of the central nervous system. A number of clinical studies have shown the effectiveness of moxonidine in the treatment of hypertension, which was comparable to the effectiveness of other modern antihypertensive drugs [4,6,9,11].
Target. The aim of this study was to evaluate the effectiveness of the combination therapy of moxonidine with an ACE inhibitor (enalapril) on the functional state of the sympathetic-adrenal system (SAS), the activity of the key enzyme of oxidative deamination of catecholamines (CA) - monoamine oxidase (MAO) in patients with type 2 diabetes with AH.
Material and methods of the study: 107 men aged 35 to 65 years (mean age 55.82±1.3 years) with a diagnosis of type 2 diabetes with hypertension, which was established in accordance with the WHO criteria (1999), were studied. and VNOK. As a control group, 20 practically healthy men aged 30-55 years were taken. Patients with type 2 diabetes with AH were randomly divided into 2 subgroups after the examination, which were comparable in age, duration of arterial hypertension and diabetes mellitus, office systolic and diastolic blood pressure. Patients of the subgroup - A - 67 people received traditional treatment, consisting of a diet (table No. 9), hypoglycemic therapy, antihypertensive therapy (enalapril at a dose of 10 mg per day);
Subgroup - B - 40 patients who also received traditional treatment, consisting of a diet (table No. 9), hypoglycemic therapy, in addition to antihypertensive therapy (enalapril at a dose of 10 mg per day) received moxonidine (physiotens) at doses of 0.2-0 .6 mg.
To judge the functional state of the CAS, the daily urinary excretion of adrenaline (A), norepinephrine (NA), dopamine (DA) and DOPA was determined by the fluorometric method modified by E.Sh. Matlina. In blood serum, MAO activity was determined by the colorimetric method of A.V. Balakleyevsky. Determination of products of lipid peroxidation (LPO) by the level of malondialdehyde (MDA) in blood serum was carried out according to the method of V.B. Gavrilova, A.R. Gavrilova and A.M. Mazhul, determined by reaction with 2-thiobarbituric acid. The diagnosis in the examined patients was established on the basis of clinical examination data, functional and laboratory-instrumental research methods. The study was carried out on the 1st day of admission to the hospital before the start of treatment, and 12 weeks after the start of treatment.
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2022 yil 30 noyabr | scientists.uz
The arithmetic mean values for the compared groups and their mean errors (M ± m) were calculated by the method of variation statistics, the significance of the difference in the compared values was determined using Student's t-test.
Research results. After the treatment, after 12 weeks, patients in subgroup A showed a positive trend in blood pressure levels, so SBP and DBP levels decreased by 15.0% and 9.7%, respectively, and in subgroup B, these indicators decreased by 16.8% and 11 ,% respectively.
From the data of Table 2 it follows that both drugs are comparable in their hypotensive effect on office SBP and DBP, while Physiotens reduced the magnitude and speed of the morning rise in blood pressure, which makes it a promising drug for the prevention of cerebral and cardiac complications of hypertension.
When analyzing the activity of the sympathoadrenal system after treatment (Table 3) in subgroup A, we observed a statistically significant decrease in the daily excretion of CA and DOPA, in relation to the initial values. Thus, the excretion of total A decreased by 12.8% (by 1.13 times) (P<0.05), NA - by 13.6% (by 1.14 times) (P<0.02), YES - by 6.4% (1.1 times) (P<0.001), DOPA - by 25.0% (1.25 times) (P<0.001). There was also a normalization of the indicators of the coefficient ratios of CA, their precursors and metabolites.
In subgroup B, after treatment with moxonidine, we observed a more pronounced statistically significant decrease in the daily excretion of CA and DOPA, and the values of these indicators were close to those of the control group. Thus, the excretion of total A decreased by 20.4% (1.2 times), NA by 25.6% (1.3 times), DA - by 8.9% (1.1 times), DOPA - by 45.4% (1.25 times) (P<0.01-0.001). There was also a normalization of the indicators of the coefficient ratios of CA, their precursors and metabolites.
When assessing blood monoamine oxidase activity in patients with type 2 DM with AH, a statistically significant decrease in MAO activity was revealed (Table 4). After active therapy with antioxidants, we noted a significant increase in enzyme activity by 20.9% (1.3 times) (P<0.001), which is higher than the initial level.
In the group receiving combined antihypertensive therapy with moxonidine, we noted a more significant significant increase in MAO activity by 27.5% (1.4 times) (P<0.001) in relation to the initial level and the approximation of these indicators to the values of the control group.
The results of the analysis of lipid peroxidation processes showed that there was a significant decrease in the secondary products of lipid peroxidation - MDA, the level of which decreased from 6.82 ± 0.44 nmol / ml to 4.43 ± 0.28 nmol / ml, which amounted to 53.8% (in 1.54 times). MDA values after treatment in this subgroup were significantly close to the value of the control group.
Discussion. Currently, DM is considered not only as a syndrome of hyperglycemia, but also as a systemic metabolic disorder, which is often combined with chronic activation of the sympathoadrenal system. Moxonidine, which selectively binds to imidazoline receptors, reduces SAS activity and produces a hypotensive effect due to a decrease in peripheral vascular tone, catecholamine secretion, renin and aldosterone activity [7], which is also confirmed by our data. Our studies have shown that a significant change in the LPO system immediately affects the activity of the SAS, which was expressed by a decrease in the daily excretion of adrenaline, norepinephrine, dopamine and DOPA, an increase in the level and improvement of the catalytic activity of MAO. In the HOT study, blood pressure targets were rarely achieved with a single antihypertensive agent [8]. In people with type 2 diabetes, the drug of choice for lowering blood
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pressure should be an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, to which, if necessary, a second antihypertensive drug is added.
The results of this study indicate that when added to the first-line antihypertensive drug moxonidine, along with an increase in the hypotensive effect, it also has a beneficial effect on the normalization of metabolic processes, which reduces the risk of developing cardiovascular complications in type 2 diabetes with hypertension. Thus, the combined antihypertensive therapy of enalapril with moxonidine in patients with type 2 diabetes with hypertension effectively reduces both systolic and diastolic blood pressure, suppressing the activity of the sympathoadrenal system, and also has a beneficial effect on carbohydrate metabolism. REFERENCES
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