Endothelial Dysfunction, Functional Structural Changes in the Vessels in Patients with the Unstable Angina with Arterial Hypertension

Introduction. One of the most actual problems of modern cardiology is the study of endothelial function, functional and structural changes in arteries, especially in patients with arterial hypertension (AH), the atherosclerotic process primarily affects the arteries of the elastic type (aorta) and slightly less – of the muscle type (brachial artery). Insufficient studies have been done to diagnose the endothelial function and arterial remodeling in the case of coronary heart disease (CHD), in particular with comorbid hypertension. Aim. To study the endothelial and functional-structural changes in blood vessels in patients with unstable angina (UA) with comorbid hypertension. Materials and methods. There were surveyed 143 men with UA and comorbid hypertension. The average age of the examined persons was 55.30 ± 0.63 years. Systolic blood pressure was 163.20 ± 1.50 mmHg, diastolic– 101.10 ± 0.67 mmHg. The duration of hypertension, according to information from the history, 9.62 ± 0.55 years. 60.1% of the surveyed previously had myocardial infarction (MI), 15.4% – two and more MI. The UA according to the classification of NYHA: II FC was diagnosed in 15.4%, and III FC – in 84.6%. Chronic heart aneurysm was in 11.2% of the patients, history of stroke was in 2.8%. Patients with neutropenia with comorbid hypertension had the following disturbances in rhythm and conduction of the heart: sinus tachycardia – in 14.0%, ventricular extrasystoles – in 4.9%, blockade of the left bundle branch of His – in 4.2 % Diagnostic constellation included: general analysis of blood and urine; coagulogram, determination of the levels of aspartate aminotransferase, alanine aminotransferase, bilirubin, creatinine, urea in blood, and for exclusion of the MI – sometimes the level of troponin I; ECG, echocardiography. To study the functional properties of the a. brachialis we have used dopplechocardiography. The initial diameter of the brachial artery, the reaction to hyperemia, which was treated as endothelium-dependent vasodilation, was determined. The test results were evaluated between the 30th and 90th seconds after the cuff was removed, which was previously applied over the shoulder and stopped the flow until the end of the 5th minute. Endothelial-independent vasodilatation was determined after 15-20 minutes of rest and taking nitroglycerin tablets. The diameter of the vessel was measured after 3 and 5 minutes. It was considered normal to increase the diameter of the brachial artery by 10.0% in 90.0 seconds during the reactive hyperemia and 20.0% in 5 minutes after taking nitroglycerin. The proposed study of the ratio of pulsed arterial pressure to shock volume, called the rigidity index of the aorta, was used to assess the overall arterial compliance. Results. It was found that in patients with unstable angina with comorbid hypertension increases the stiffness of the aorta, due to the increase in systolic, diastolic and pulse blood pressure. In these patients there is endothelial dysfunction with decreased endothelium-dependent and endothelium-independent vasodilation of the brachial artery, resulting in structural changes in the arteries. In patients with unstable angina, combined with hypertension, there were found the increased thickness of the intima-media complex, due to remodeling and changes in the structure of the brachial artery. Conclusions. In patients suffering from the unstable angina with the AH there was defined the increase of the index of rigidity of aorta, blood pressure, thickness of intima-media complex, decrease of the vasodilatation, remodeling and change in structure of the brachial artery that must be taken into account in the treatment algorithm.