Международный эндокринологический журнал Том 18, №5, 2022

Актуальність. Неконтрольований артеріальний тиск (АТ), особливо на фоні стресу, пов’язаний з чотириразовим збільшенням ризику розвитку серцево-судинних подій порівняно з пацієнтами з артеріальною гіпертензією (АГ), які досягли цільового рівня АТ. Мета дослідження: оцінити механізми впливу стресу на розвиток артеріальної гіпертензії, типів артеріальної гіпертензії і резистентність. Матеріали та методи. У дослідження було включено 1146 пацієнтів з резистентною АГ, які приймали 3 і більше антигіпертензивних препарати і лікувалися у відділенні вторинних і легеневих гіпертензій ДУ «ННЦ «Інститут кардіології, клінічної і регенеративної медицини ім. акад. М.Д. Стражеска» НАМН України. Рівень офісного АТ при надходженні у відділення при прийомі трьох і більше антигіпертензивних препаратів становив: систолічного — 174,60 ± 0,64 мм рт.ст., діастолічного — 100,50 ± 0,38 мм рт.ст. Пацієнтам проводили наступні обстеження: вимірювання офісного АТ, добове моніторування артеріального тиску, ехокардіографічне дослідження, визначення нічного апное сну, загальний аналіз крові, біохімічний аналіз крові, визначення рівнів тиреотропного гормону, трийодтироніну, тироксину, реніну крові, альдостерону крові та їх співвідношення, визначення метанефринів сечі, кортизолу. Результати. Серед пацієнтів з резистентною артеріальною гіпертензією жінок було більше, ніж чоловіків — 62,7 % проти 36,7 % відповідно. У дослідженні пацієнтів з резистентною АГ, у яких не було досягнуто цільового рівня систолічного АТ, спостерігались достовірно вищі показники АТ при надходженні в стаціонар. У них був достовірно вищий рівень кортизолу крові (155,0 ± 44,0 нг/л проти 35,9 ± 20,8 нг/л, р = 0,026), вищий індекс маси міокарда лівого шлуночка (147,50 ± 3,46 г/м2 проти 135,3 ± 1,74 г/м2), частіше відзначалося ожиріння (42,9 % проти 37,5 %). Висновки. Пацієнти з резистентною артеріальною гіпертензією, які не досягли цільового рівня артеріального тиску, мали вищий рівень кортизолу й індекс маси міокарда лівого шлуночка порівняно з пацієнтами, у яких було досягнуто цільових рівнів артеріального тиску.

Background. Uncontrolled blood pressure (BP), especially in the context of stress, is associated with a fourfold increase in the risk of developing cardiovascular events compared to patients with hypertension who have reached the target BP level. Aim: to evaluate the mechanisms of the influence of stress on the development of hypertension, types of hypertension and resistance. Materials and methods. The study included 1,146 patients with resistant hypertension who were taking 3 or more antihypertensive drugs and were treated at the department of secondary and pulmonary hypertensions of the State Institution “National Scientific Center “M.D. Strazhesko Institute of Cardiology” of the National Aca­demy of Medical Sciences of Ukraine”. The level of office blood pressure upon admission to the department when taking 3 or more antihypertensive drugs was: systolic — 174.60 ± 0.64 mmHg, diastolic — 100.50 ± 0.38 mmHg. Patients underwent the following examinations: measurement of office blood pressure, daily blood pressure monitoring, echocardiography, measurement of nocturnal sleep apnea, general blood analysis, biochemical blood analysis, determining the levels of thyroid-stimulating hormone, triiodothyronine, thyroxine, blood renin, blood aldosterone and their ratio, urine metanephrines, blood cortisol. Results. Among patients with resistant hypertension, there were more women than men — 62.7 versus 36.7 %, respectively. In a study of people with resistant hypertension who did not reach the target level of systolic BP, significantly higher indicators of BP were observed upon admission to the hospital. They had a significantly higher blood cortisol level (155.0 ± 44.0 vs. 35.9 ± 20.8 ng/l, p = 0.026), higher left ventricular mass index (147.50 ± 3.46 vs. 135.30 ± 1.74 g/m2), obesity was more common among them (42.9 versus 37.5 %). Conclusions. Patients with resistant hypertension who did not reach the target level of blood pressure had higher level of cortisol and left ventricular mass index compared to those who achieved the target levels of blood pressure.

симпатоадреналова система; стрес; артеріальна гіпертензія; резистентна гіпертензія; С- і Н-тип артеріальної гіпертензії

sympathoadrenal system; stress; hypertension; resistant hypertension; C and H type hypertension

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