HORMONAL AND VEGETATIVE FACTORS OF INSULIN RESISTANCE IN PATIENTS WITH HYPERTENSION
Keywords:arterial hypertension, resistance, hemodynamics, hormonal and vegetative factors
The combination of arterial hypertension (AH) and insulin resistance (IR) significantly increases the risk of cardiovascular complications. Research objective: Studying indices of carbohydrate metabolism, activity of renin-angiotensin-aldosterone system, calcium-regulating hormones, adrenal glucocorticoid function, the condition of the autonomic nervous system and their possible interrelation with hemodynamic parameters in AH patients with different insulin sensitivity. A comprehensive study of hormonal profile was held with use of radio immune method and that of central hemodynamics with use of echocardiography in 72 patients with arterial hypertension stage II, 1-2 degrees, male (mean age – 54.1±3.4 years), with a body mass index up to 30 kg / mІ and verified insulin resistance (IR), in 32 patients of which insulin resistance (IR) was revealed, and in 40 patients its absence was fixed. Insulin resistance was verified by the value of HOMA-IR in excess of 2,77. To assess the condition of the autonomic nervous system, studies of heart rate variability were performed. It is established that patients with hypertension with IR had increased level of plasma renin activity, levels of angiotensin II, cortisol, insulin, parathyroid hormone, decreased parasympathetic and increased sympathetic tonus. According to the results of factor analysis, AH with insulin resistance has a distinctive structure of neurohumoral regulation of the main indicators of central hemodynamics and interhormonal interactions; the direct regulatory effects of angiotensin II, insulin, progesterone, parathyroid hormone on the indicators of central hemodynamics, modulation of presorption action increases. The study not only revealed peculiarities of neurohumoral profiles in patients with hypertension depending on insulin resistance, but also determined distinctive features in structure of the regulatory process of central hemodynamics and interhormonal interactions. This should be taken into account when prescribing antihypertensive therapy.
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