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Влияние степени нарушений углеводного обмена на тяжесть артериальной гипертонии, распространенность и выраженность поражения органов-мишеней у больных с метаболическим синдромом
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Аннотация
В настоящее время все шире обсуждается вопрос о влиянии различных метаболических нарушений и их сочетания на распространенность и выраженность поражения органов-мишеней (ПОМ) у больных артериальной гипертонией (АГ). С целью изучения влияния варианта (степени) нарушений углеводного обмена на тяжесть АГ (степень АГ и показатели суточного мониторирования артериального давления – СМАД), распространенность и выраженность ПОМ обследованы 403 пациента с метаболическим синдромом. В результате исследования установлено, что у пациентов, имеющих нарушение толерантности к глюкозе (НТГ) по сравнению с пациентами с нарушением гликемии натощак и тем более по сравнению с пациентами без явных нарушений углеводного обмена, регистрируются более выраженные изменения параметров СМАД, они страдают более тяжелой степенью АГ, у них выявляются более тяжелые поражения сердца и почек, однако это не относится к атеросклеротическому поражению экстракраниальных артерий. Таким образом, НТГ, являясь более тяжелой степенью (вариантом) нарушения углеводного обмена, может сопровождаться возрастанием риска сердечно-сосудистой заболеваемости и сахарного диабета типа 2 у данных больных.
Ключевые слова: метаболический синдром, компоненты метаболического синдрома, артериальная гипертония, органы-мишени.
Ключевые слова: метаболический синдром, компоненты метаболического синдрома, артериальная гипертония, органы-мишени.
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At present the question concerning the influence of various metabolic disturbances and their combination on prevalence and manifestation of target organ damage in patients with hypertension is widely discussed. 403 patients with metabolic syndrome were examined purposely to study the influence of the variation (rate) carbohydrate metabolism disturbances on hypertension severity (hypertension stage, 24-hour ambulatory blood pressure monitoring), prevalence and manifestation of target organ damage. The research showed that patients with impaired glucose tolerance compared to those with impaired fasting glucose and moreover, to patients without obvious carbohydrate metabolism abnormalities, have more pronounced variability/changes of blood pressure indicators, and suffer from a more severe degree of hypertension, they have more severe heart and renal damage, but this is not relevant to extracranial atherosclerotic carotid lesions. Therefore, impaired glucose tolerance as more severe of carbohydrate metabolism abnormality can be accompanied by the increase of cardiovascular disease morbidity risk and diabetes mellitus type 2 in these patients.
Key words: metabolic syndrome, metabolic syndrome components, arterial hypertension, target organs.
Полный текст
Список литературы
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17. Verdecchia P, Schillaci G, Borgioni C et al. Adverse prognostic significance of concentric remodeling of the left ventricle in hypertensive patients with normal left ventricular mass. J Am Coll Cardiol 1995; 25: 871–78.
18. Agabiti-Rosei E, Muiesan ML, Salvetti M. Evaluation of subclinical target organ damage for risk assessment and treatment in the hypertensive patients: left ventricular hypertrophy. J Am Soc Nephrol 2006; 17 (4 Suppl. 2): S104–8.
19. Ferrara LA, Cardoni O, Mancini M, Zanchetti A. Metabolic syndrome and left ventricular hypertrophy in a general population. Results from the Gubbio Study. J Hum Hypertens 2007; 21 (10): 795–601.
20. Chang Y, Yoo T, Ryu S et al. Abdominal obesity, systolic bood pressure and MAU in normotensive and euglicemic Korean men. Int. Obes (lond) 2006; 30 (5): 800–4.
21. Takiuchi S, Kamide K, Miwa Y et al. Diagnostic value of carotid intima–media thickness and plaque score for predicting target organ damage in patients with essential hypertension. J Hum Hypertens 2004; 18 (1): 17–23.
22. Cirillo M, Senigalliesi L, Laurenzi M et al. Microalbuminuria in nondiabetic adults; relations of blood pressure, body mass index, plasma cholesterol levels and smoking The GUBBIO Population Study. Arch Intern Med 1998; 158 (17): 1933–39.
23. Chen J, Muntner P, Hamm LL et al. The metabolic syndrome and chronic kidney disease in US adults. Ann Intern Med 2004; 140: 167–74.
24. De Simone G, Olsen MH, Wachtell K et al. Clusters of metabolic risk factors predict cardiovascular events in hypertension with target-organ damage: the LIFE study. J Hum Hypertens 2007; 21 (8): 625–32.
2. Reaven GM. Banting Lecture 1988. Role of insulin resistance in human disease. Diabetes 1988; 37: 1595–607.
3. Carr DB, Utzschneider KM, Hull RL et al. Intra-abdominal fat is a major determinant of the National Cholesterol Education Program Adult Treatment Panel III criteria for the metabolic syndrome. Diabetes 2004; 53: 2087–94.
4. Julius S, Gudbrandsson T, Jamerson K et al The hemodynamic link between insulin resistance and hypertension. J Hypertens 1991; 9: 983–86.
5. Mule G, Nardi E, Cottone S et al. Influence of metabolic syndrome on hypertension-related target organ damage. J Intern Med 2005; 257: 503–13.
6. Schilacci G, Pirro M, Vaudo G et al. Metabolic syndrome is associated with aortic stiffness in untreated essential hypertension. Hypertension 2005; 45: 1978–82.
7. Cuspidi C, Meani S, Fusi V et al Prevalence and correlates of left atrial enlargement in essential hypertension: role of ventricular geometry and the metabolic syndrome: the Evaluation of Target Organ Damage in Hypertension study. J Hypertens 2005; 23: 875–82.
8. Kavamoto R, Tomita H, Oka Y et al. Metabolic syndrome amplifies the LDL-cholesterol associated increases in carotid atherosclerosis. Intern Med 2005; 44: 1232–38.
9. Cuspidi C, Meani S, Fusi V et al. Ambulatory blood pressure, target organ damage and left atrial size in never-treated essential hypertensive individuals. J Hypertens 2005; 23: 1589–95.
10. Mulè G, Nardi E, Cottone S et al. Influence of metabolic syndrome on hypertension-related target organ damage. J Intern Med 2005; 257 (6): 503–13.
11. Navarro J, Redón J, Cea-Calvo L et al. Metabolic syndrome, organ damage and cardiovascular disease in treated hypertensive patients. The ERICHTA study. Blood Press 2007; 16 (1): 20–7.
12. Cuspidi C, Meani S, Valerio C et al. Age and target organ damage in essential hypertension: role of the metabolic syndrome. Am J Hypertens 2007; 20 (3): 296–303.
13. Cuspidi C, Sala C, Zanchetti A. Metabolic syndrome and target organ damage: role of blood pressure. Expert Rev Cardiovasc Ther 2008; 6 (5): 731–43.
14. Cuspidi C, Valerio C, Giudici V et al. Metabolic syndrome and multiple organ damage in essential hypertension. Blood Pressure 2008; 17: 195–203.
15. Eguchi K, Schwartz JE, Roman MJ et al. Metabolic syndrome less strongly associated with target organ damage than syndrome components in a healthy, working population. J Clin Hypertens (Greenwich) 2007; 9 (5): 337–44.
16. Recommendations for Chamber Quantification: A Report from the American Society of Еchocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, Developed in Conjunction with European Association of Echocardiography. J Am Soc Echocardiogr 2005; 18: 1446–7.
17. Verdecchia P, Schillaci G, Borgioni C et al. Adverse prognostic significance of concentric remodeling of the left ventricle in hypertensive patients with normal left ventricular mass. J Am Coll Cardiol 1995; 25: 871–78.
18. Agabiti-Rosei E, Muiesan ML, Salvetti M. Evaluation of subclinical target organ damage for risk assessment and treatment in the hypertensive patients: left ventricular hypertrophy. J Am Soc Nephrol 2006; 17 (4 Suppl. 2): S104–8.
19. Ferrara LA, Cardoni O, Mancini M, Zanchetti A. Metabolic syndrome and left ventricular hypertrophy in a general population. Results from the Gubbio Study. J Hum Hypertens 2007; 21 (10): 795–601.
20. Chang Y, Yoo T, Ryu S et al. Abdominal obesity, systolic bood pressure and MAU in normotensive and euglicemic Korean men. Int. Obes (lond) 2006; 30 (5): 800–4.
21. Takiuchi S, Kamide K, Miwa Y et al. Diagnostic value of carotid intima–media thickness and plaque score for predicting target organ damage in patients with essential hypertension. J Hum Hypertens 2004; 18 (1): 17–23.
22. Cirillo M, Senigalliesi L, Laurenzi M et al. Microalbuminuria in nondiabetic adults; relations of blood pressure, body mass index, plasma cholesterol levels and smoking The GUBBIO Population Study. Arch Intern Med 1998; 158 (17): 1933–39.
23. Chen J, Muntner P, Hamm LL et al. The metabolic syndrome and chronic kidney disease in US adults. Ann Intern Med 2004; 140: 167–74.
24. De Simone G, Olsen MH, Wachtell K et al. Clusters of metabolic risk factors predict cardiovascular events in hypertension with target-organ damage: the LIFE study. J Hum Hypertens 2007; 21 (8): 625–32.
Авторы
Ю.В.Жернакова, И.Е.Чазова, Г.Х.Шарипова, С.П.Олимпиева, В.В.Киликовский
Институт клинической кардиологии им. А.Л.Мясникова ФГУ РКНПК Минздравсоцразвития РФ, Москва
Институт клинической кардиологии им. А.Л.Мясникова ФГУ РКНПК Минздравсоцразвития РФ, Москва
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Yu.V.Zhernakova, I.E.Chazova, G.Kh.Sharipova, S.P.Olimpiyeva, V.V.Kilikovsky
A.L. Myasnikov Institute of Clinical Cardiology, Russian Cardiology Research-and-Production Complex, Ministry of Health and Social Development of the Russian Federation, Moscow
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