SKIN MICROCIRCULATORY ORGANIZATION TYPES IN ARTERIAL HYPERTENSION BY THE DATA OF DOPPLER FLOWMETRY

Aim. To assess types of functional shifts at the microcirculatory level (MC) in patients with arterial hypertension (AH) with different level of microvascular resistance. Material and methods. Healthy (n=34) volunteers and patients with AH 2-3 grade (n=79) and high (n=30) level of microvascular resistance of the skin were assessed for MC with laser doppler flowmetry.Results. No matter the comparable level of blood pressure (BP) in groups with AH, the differences of MC pattern in patients with high vascular resistance are the same and present with a venous congestion resulting in an intensification of arterial-venular shunting of the blood and decreased venous backflow. As the load of the blood coming into microcirculatory stream in the AH groups investigated is identical, constriction of precapillares and dumping of blood by shunts is related to significant decrease of nutritive blood flow. Negative character of microhaemocirculation in this case is confirmed by the higher prevalence of worse prognostic types of hemodynamics and higher microalbuminuria level.Conclusion. Decreased nutritive productivity of MC in patients with high microvascular resistance suggests more prominent negative influence on target organs that requires more active hypotensive therapy with consideration of MC shifts. Also the expediency cannot be disregarded of the inclusion of strong vasolytic agents in complex therapy

MICROCIRCULATION IN HEALTHY PEOPLE AND HYPERTENSIVE PATIENTS WITH DIFFERENT VARIANTS OF PERIPHERAL HEMODYNAMICS

The study was analyzing the features of identical hemodynamic microcirculation types (HMT) in healthy people and patients with arterial hypertension (AH). In total, 80 patients with Stage II-III AH and 39 healthy men and women were included in the study. In AH patients, all HMT variants were characterised by pre-capillary vasoconstriction, to some extent compensated due to increased pulse filling of micro-vessels. Both in healthy people and AH patients, normocirculatory HMT could be regarded as the most balanced. Venous hyperemia was typical for AH patients with hyperemic HMT, due to intensified microcirculatory regulation processes. Low tissue perfusion in healthy people and AH patients with spastic HMT could be explained by advanced vascular and extravasal changes. Healthy participants with congestive HMT also had demonstrated intensification of active microcirculation control mechanisms – endothelial, neurogenic, and myogenic ones. AH patients, on the contrary, were characterised by depression of peripheral hemodynamics-regulating mechanisms. HMT analysis could facilitate identification of healthy people with higher disease risk, as well as AH patients with high risk of target organ damage and poor prognosis

Microcirculatory function in patients with arterial hypertension, metabolic syndrome and diabetes mellitus

Aim. To assess microcirculatory (MC) function in patients with arterial hypertension (AH), AH and metabolic syndrome (MS), AH, MS and Type 2 diabetes mellitus (DM-2).Material and methods. In total, 96 patients with Stage I-II AH and 26 healthy individuals were examined. All patients were divided into three groups: Group I (no clinical or laboratory evidence for MS and DM-2), Group II (MS), Group III (MS and DM-2). In all participants, lipid profile and forearm skin MC (laser Doppler flowmetry method) were assessed.Results. Combination of AH and MS or DM-2 was associated with progressive MC deterioration (increased vasoconstriction, activated passive mechanisms of MC tonus regulation, reduced blood flow effectiveness due to non-capillary bypass, decreased tissue perfusion reserve, prevalent congestive and static MC types).Conclusion. Modern methods of MC assessment in clinical practice provide additional objective information about disease severity and prognosis, which is especially important for patients with MS and DM-2

Functional characteristics of microcirculation and their prognostic value in patients with arterial hypertension

Aim. To study functional characteristics of microcirculation (MC), various hemodynamic variants of peripheral hemocirculation, and their clinical and prognostic value in patients with arterial hypertension (AH). Material and methods. The study included 78 AH patients (mostly with Stage II-III AH) and 29 healthy individuals. Forearm skin MC was assessed by laser Doppler flowmetry. Results. In AH patients, substantially elevated pre-capillary tone resulted in reduced nutritive blood flow, increased total peripheral vascular resistance, arteriolovenular shunting, and venous hyperemia. The depression of the main MC regulatory mechanisms was partly compensated by passive, breath and pulse-related factors. Conclusion. Among all hemodynamic MC types, the negative effects on target organs and prognosis were maximal for spastic and congestive-stasic MC variants. MC types should be taken into account when choosing optimal strategy of pharmaceutical treatment

Possible mechanisms of hypercholesterolemia and clinico-prognostic effects of lipid-lowering therapy in patients with coronary heart disease. (Literature review and original data analysis)

In this article, possible ways of hypercholesterolemia development are analyzed. The authors discuss the role of cell membrane function in cholesterol homeostasis. Taking into account structural and functional stabilization of biomembranes, lipidlowering and pleiotropic effects of statins are analyzed. Association between blood cholesterol level and coronary heart disease (CRT)) prognosis, possibly of indirect nature, is discussed