Features of arterial hypertension in patients with pubertal hypothalamic syndrome and ways to optimise its therapy

The dissertation is devoted to the study of the features of arterial hypertension in pubertal patients with hypothalamic syndrome. It examines the mechanisms of the development of hypertension in this pathology, the clinical manifestations of disturbances of autonomic regulation of the cardiovascular system, and the state of haemodynamics and metabolic processes. On the basis of ambulatory blood pressure monitoring, assessment of heart rate variability and echocardiographic data, a comparative analysis of the examined groups was carried out. Particular attention is paid to the evaluation of the effectiveness of antihypertensive therapy with the cardioselective β-adrenoblocker bisoprolol and the angiotensin-converting enzyme inhibitor enalapril, as well as to their influence on the 24-hour blood pressure profile and autonomic regulation.

The problem of arterial hypertension in Russia remains highly relevant due to its frequent occurrence and pronounced social significance. It has been found that a considerable proportion of patients suffer from this pathology from a young age. According to data from individual studies, 40–65% of cases of arterial hypertension that arise at a young age progress to the category of "adult" pathology [86]. Juvenile hypertension is currently insufficiently studied, although it is very important to identify and treat precisely young patients in order to prevent the inevitable subsequent damage to target organs.

Arterial hypertension is the second most frequent symptom in patients with pubertal hypothalamic syndrome (PHSP) and occurs in 50–75% of its cases [37]. To date, the state of haemodynamics, the circadian rhythm of blood pressure and its autonomic regulation have been little studied, and the correlation of haemodynamic parameters with metabolic disturbances in these patients has not been clarified. The question of methods and means of correcting arterial hypertension in PHSP remains debatable, given that antihypertensive therapy in such patients must be prescribed with account of the possible adverse effects of a number of drugs on carbohydrate and lipid metabolism.

The above determined the aim and objectives of the present study. Aim of the study

To clarify the features of arterial hypertension in patients with PHSP. On the basis of this, to determine approaches to antihypertensive therapy in these patients.

Objectives of the study

1. To identify features of the 24-hour blood pressure profile in patients with PHSP.

2. To study features of the state of autonomic regulation of the cardiovascular system on the basis of heart rate variability indices in this category of patients.

3. To assess the state of central and intracardiac haemodynamics, as well as the systolic and diastolic function of the left ventricle.

4. To identify features of lipid and carbohydrate metabolism in young men with PHSP.

5. On the basis of the data obtained, to attempt to determine optimal approaches to the treatment of arterial hypertension in patients with PHSP.

Main propositions put forward for defence

1. Patients with PHSP are characterised by persistent grade 1 systolic arterial hypertension predominantly in the daytime, disturbance of the 24-hour blood pressure profile in 50% of patients predominantly of the "non-dipper" type, increased variability of systolic and diastolic blood pressure, and an increased magnitude of the morning rise in systolic blood pressure.

2. A feature of autonomic regulation of the cardiovascular system in PHSP patients with arterial hypertension is a shift of regulation to a lower humoral-metabolic level at rest, a significant decrease in the reactivity of the autonomic nervous system, and an increase in the influence of cerebral ergotropic structures on blood pressure level during transition to orthostasis, as evidenced by the study of heart rate variability.

3. Therapy with the cardioselective β-adrenoblocker Concor leads to normalisation of average 24-hour and daytime values of systolic blood pressure, a decrease in the time index of systolic blood pressure during the daytime, a reduction in the magnitude of the morning rise in systolic blood pressure, an increase in total spectral power, and a reduction in the influence of catecholamines on the cardiovascular system.

Scientific novelty

For the first time, the features of arterial hypertension in PHSP patients have been studied, and heart rate variability in these patients has been investigated.

For the first time, a relationship has been established between heart rate variability indices in PHSP patients and the 24-hour blood pressure profile, as well as the level of C-peptide.

For the first time, features of lipid, carbohydrate and catecholamine metabolism in PHSP patients with arterial hypertension have been clarified, and relationships between catecholamine levels and the 24-hour blood pressure profile have been identified.

For the first time in PHSP patients with arterial hypertension, a comprehensive clinical and instrumental assessment of the effectiveness of treatment with antihypertensive drugs (Concor and Renitec) has been carried out.

Practical significance of the work

Combined recording of the dynamics of 24-hour blood pressure indices and heart rate variability makes it possible to substantiate antihypertensive therapy in PHSP patients with arterial hypertension from pathogenetic positions and to evaluate its effectiveness.

A stimulating influence of humoral-metabolic factors in the pathogenesis of arterial hypertension in PHSP patients has been revealed.

A corrective effect of bisoprolol and enalapril on ambulatory blood pressure monitoring indices and heart rate variability indices in PHSP patients with arterial hypertension has been demonstrated.

Implementation of the study results

The results of the study have been implemented into the practice of the Cardiology and Endocrinology Departments of the N. A. Semashko Nizhny Novgorod Regional Clinical Hospital.

Approval of the work

The materials and main propositions of the dissertation were reported at the Nizhny Novgorod Regional Scientific and Practical Conference "Interrelation and Interdependence of Arterial Hypertension and Concomitant Diseases. Strategy of Therapy" (Nizhny Novgorod, 2006), and at a joint meeting of the V. G. Vogralik Department of Hospital Therapy and the Problem Commission "Internal Diseases, Cardiology, Toxicology, Allergology, Endocrinology, Pharmacology" (Nizhny Novgorod, 2006).

Publications

Ten printed works have been published on the topic of the dissertation.

Structure and scope of the work