Features of the Severity of Cardiovascular Remodeling and Metabolic Disorders in Hypertensive Patients with Obesity in the Presence of Two Unfavorable Genotypes of the ADIPOQ and IRS-1 Genes

The results of a number of studies have shown that in arterial hypertension (AH), G/T and T/T genotypes of the adiponectin gene (ADIPOQ) and Gly/Arg and Arg/Arg genotypes of the insulin receptor substrate 1 gene (IRS-1) are associated with a greater severity of metabolic disorders and hemodynamic parameters compared with G/G and Gly/Gly genotypes of these genes. The aim of the study: to evaluate the severity of cardiovascular remodeling and metabolic disorders in hypertensive obese patients in the simultaneous presence of two unfavorable genotypes of the ADIPOQ and IRS-1 genes. Methods: We examined 300 AH patients: 200 patients with AH and obesity, 50 patients with AH and normal body weight, 50 patients with AH and overweight, 40 patients with AH, obesity and type 2 diabetes mellitus (DM2), 30 healthy individuals. The polymorphisms of the ADIPOQ and IRS-1 was assessed by molecular genetic method. Results: It was found that in all groups of hypertensive patients, regardless of body weight and the presence of DM2, the simultaneous presence of two unfavorable genotypes of the ADIPOQ and IRS-1 genes occurred significantly more often than in healthy individuals: in 41% of AH patients with obesity, 30% of AH patients with normal weight, 40% of AH with overweight, 57.5% of AH with obesity and DM2 vs. 13.3% of healthy individuals. In hypertensive patients, in the presence of overweight and obesity, the frequency of combination of the two unfavorable genotypes of these genes was significantly higher than in AH patients with normal body weight. Conducting comparative evaluation of AH patients with obesity depending on the presence of two unfavorable genotypes or two protective genotypes of the ADIPOQ and IRS-1 genes showed that carriers of the combination of the G/T + T/T genotype of the ADIPOQ and the Gly/Arg + Arg/Arg genotype of the IRS-1 had a higher body mass index, more pronounced insulin resistance, cardiovascular remodeling, adipokine imbalance, impaired carbohydrate and lipid metabolism. Conclusions: In AH patients, the frequency of the simultaneous presence of two unfavorable polymorphisms of ADIPOQ and IRS-1 genes was higher than in healthy individuals. In AH patients with overweight and obesity, the frequency of combination of the two unfavorable genotypes of the ADIPOQ and IRS-1 genes was significantly higher than in normal body weight. The presence of a combination of two unfavorable genotypes of the ADIPOQ and IRS-1 genes in patients with AH and obesity was associated with a greater severity of cardiovascular remodeling and metabolic disorders compared with the combination of two protective genotypes of these genes

Особливості метаболічних показників у пацієнтів із гіпертонічною хворобою і супутнім ожирінням залежно від поліморфізму гена адипонектину

Мета дослідження полягала у вивченні асоціації генетичного поліморфізму маркера G276T гена адипонектину зі змінами мета - болічних показників у пацієнтів із гіпертонічною хворобою (ГХ) і супутнім ожирінням. Обстежено 300 пацієнтів із ГХ віком від 45 до 55 років, які дали інформовану письмову згоду на участь у дослідженні і відповідали критеріям включення. До першої групи ввійшло 200 пацієнтів із ГХ у поєднанні з ожирінням І–ІІ ступенів, до другої групи – 50 пацієнтів із ГХ і нормальною масою тіла, до третьої групи – 50 пацієнтів із ГХ та надлишковою масою тіла. Контрольну групу становили 30 практично здорових осіб, в яких ГХ та ожиріння були виключені на підставі даних клініко-інструментального дослідження. У результаті проведеного дослідження встановлена асоціація алеля Т поліморфного маркера G276T гена адипонектинуз розвитком коморбідності ГХ та ожиріння. Доведено, що поліморфізм гена адипонектину впливав на зміни метаболічних показників у пацієнтів із ГХ та ожирінням: при G/Т- і Т/Т генотипах мали місце більш виражені порушення метаболічних показників, ніж при G/G-генотипі. G/Т- і Т/Т-генотипи поліморфного маркера G276T гена адипонектину були пов’язані з достовірно більшим індексом маси тіла, вищими рівням и тригліцеридів, більш вираженою інсулінорезистентністю та дисбалансом адипокінів.The main component of the metabolic syndrome (MS) is the abdominal obesity (AO) which inevitably leads to insulin resistance (IR). Adiponectin (AN) secreted by the adipocytes protects from the IR development, increases the sensitivity of skeletal muscles to insulin, reduces intake of free fatty acids in a liver and, thus reduces the synthesis of atherogenic lipoproteins. Some investigations prove that the level of the adiponectin in blood plasma correlates back with the mass of the fatty tissue, the waist-hip ratio and IR expressiveness. With obesity, AN secretion decreases, losing its protective role as for the risk of IR development and metabolic violations. It is known that ADIPOQ gene has several polymorphic sites, which influence the production and activity of AN. Allelic options of its polymorphic marker G276T are associated with the development of the AO, IR, and diabetes. The aim of the study was to investigate the association of the genetic polymorphism of the G276T marker of the adiponectin gene with changes in metabolic parameters in patients with arterial hypertension (AH) and concomitant obesity. We examined 300 patients with AH 45 to 55 years old who gave informed written consent to participate in the study and met the inclusion criteria. Group 1 consisted of 200 patients with AH and class I–II obesity, group 2–50 patients with AH and normal body weight, group 3–50 patients with AH and overweight. The control group consisted of 30 practically healthy individuals, in whom AH and obesity were excluded on the basis of clinical and instrumental examination data. As a result of the study the association of T-allele of the polymorphic marker G276T of the adiponectin gene with the development of comorbidity of AH and obesity was established. It has been proven that adiponectin gene polymorphism influenced changes in metabolic parameters in hypertensive patients with obesity: more pronounced impairment of metabolic parameters in G/T and T/T genotypes as compared to G/G genotype. G/T and T/T genotypes of the polymorphic marker G276T of the adiponectin gene were associated with a significantly higher body mass index, higher triglyceride levels, more pronounced insulin resistance and adipokine imbalance

Features of metabolic and hemodynamic indicators in obese patients with resistant hypertension

Objective: To establish the features of metabolic and hemodynamic parameters in obese patients with true and pseudo-resistant arterial hypertension (AH)

The Role of Genetic Polymorphism in the Formation of Arterial Hypertension, Type 2 Diabetes and their Comorbidity

Background: Hereditary component plays a significant role in the formation of insulin resistance (IR) - one of the pathogenetic links of arterial hypertension (AH) and type 2 diabetes mellitus (DM2). However, the genetic predisposition to IR can not be realized and does not manifest itself clinically in the absence of appropriate factors of the environment (excessive nutrition, low physical activity, etc.). Objective: The review summarizes the results of studies which describe the contribution of genetic polymorphism to the formation and progression of AH, DM2 and their comorbidity in various populations. Results: In many studies, it has been established that genetic polymorphism of candidate genes is influenced by the formation, course and complication of AH and DM2. According to research data, the modulating effect of polymorphism of some genetic markers of AH and DM2 on metabolism and hemodynamics has been established. The results of numerous studies have shown a higher frequency of occurrence of AH and DM2, as well as their more severe course with adverse genetic polymorphisms. At the same time, the role of genetic polymorphism in the formation of AH and DM2 differs in different populations. Conclusion: Contradictory data on the influence of gene polymorphisms on the formation of AH and DM2 in different populations, as well as a small number of studies on the combined effects of several polymorphisms on the formation of comorbidity, determine the continuation of research in this direction

Hemodynamic and metabolic disorders in obese patients with resistant hypertension

Patients with resistant hypertension differed from hypertensive obese patients without resistance with higher BMI and BP, higher levels of triglycerides, insulin, HbA1c, more pronounced IR, cardiovascular remodeling, imbalance of oxidative stress - antioxidant protection system, higher proinflammatory and RAAS activity. Patients with true resistance differed from pseudo-resistant patients with significantly lower BMI, higher aldosterone levels, more pronounced imbalance of the system of oxidative stress - antioxidant protection and less pronounced adipokines imbalance

Клініко-лабораторні особливості хворих з коморбідністю бронхіальної астми та ожиріння

Актуальність роботи обумовлена збільшенням поширеності фенотипу бронхіальної астми з ожирінням та його більш важким перебігом. Мета роботи – дослідити вплив надлишкової маси тіла на параметри клініко-лабораторного стану хворих на бронхіальну астму. Обстежено 132 хворих на бронхіальну астму (76 жінок та 56 чоловіків), віком 35–60 років, 30 хворих з нормальною вагою та 102 хворих з індексом маси тіла від 25,0 кг/м2 і більше. Встановлено, що хворі на бронхіальну астму з надлишковою вагою мають більшу тривалість захворювання (на 28,6 %) та прийому кортикостероїдів (на 27,0 %), вищий серцево-судинний ризик, асоційований з підвищенням рівня діастолічного артеріального тиску (на 5,3 %), зниженням ліпопротеїдів високої щільності (на 65,7 %), підвищенням ліпопротеїдів низької щільності (на 13,2 %) та рівня глюкози (на 5,1 %), збільшенням інтерлейкіну-6 (на 31,8 %). Виявлені кореляції надмірної ваги у хворих на бронхіальну астму з віком, показниками спірометрії та рівнем контролю симптомів.The relevance of the study is due to the increased prevalence of the phenotype of bronchial asthma with obesity and its more severe course. The purpose of the study was to investigate the effect of excess body weight on the parameters of the clinical and laboratory condition of patients with bronchial asthma. 132 patients with bronchial asthma (76 women and 56 men), aged 35– 60 years, 30 patients with normal weight and 102 patients with a body mass index of 25.0 kg/m2 and more were examined. It was found that overweight patients with bronchial asthma have a longer duration of the disease (by 28.6 %) and corticosteroids (by 27.0 %), higher cardiovascular risk associated with increased diastolic blood pressure (by 5.3 %), decreased high-density lipoprotein (by 65.7 %), an increase in low-density lipoprotein (by 13.2 %) and glucose levels (by 5.1 %), an increase in interleukin-6 (by 31.8 %). Overweight correlations with age, spirometry, and symptom control were found in patients with asthma

Features of hemodynamic and metabolic disorders in obese patients with resistant hypertension

The aim was to establish the features of hemodynamic and metabolic parameters in obese patients with true and pseudo-resistant arterial hypertension (AH). Material and methods. The study included 200 patients with uncontrolled AH and obesity. Patients were initially prescribed dual antihypertensive therapy. Those patients who did not reach target blood pressure (BP) levels after 3 months on dual therapy were additionally prescribed a third antihypertensive drug. Of the 98 patients who were assigned to triple therapy, 48 patients did not reach target BP (27 patients had pseudo-resistant and 21 patients had true resistant AH). These patients were additionally prescribed a fourth antihypertensive drug (spironolactone). The effectiveness of the treatment was evaluated 6 months after the start of antihypertensive therapy. Results. After 6 months of therapy, unlike patients without resistance, individuals with resistant AH had more pronounced cardiovascular remodeling and metabolic disorders, disbalance of oxidative stress-antioxidant protection, proinflammatory activity and higher activity of the renin-angiotensin-aldosterone system. Patients with true resistance differed from pseudo-resistant patients by having significantly lower body mass index (BMI); in the absence of differences in BP levels, cardiovascular remodeling, lipid and carbohydrate profiles, patients with true resistance had significantly higher levels of aldosterone, higher activity of oxidative stress system, lower levels of general antioxidant protection, higher adiponectin levels, and lower leptin level. Conclusions. Obese patients with true resistance differed from pseudo-resistant patients by having significantly lower BMI, higher aldosterone levels, more pronounced imbalance of the system of oxidative stress-antioxidant protection and less pronounced adipokine imbalance