kurskvestЧеловек и его здоровьеHumans and their health1998-57461998-5754Kursk State Medical University10.21626/vestnik/2022-1/03kurskvest-991Research ArticleКЛИНИЧЕСКАЯ МЕДИЦИНАCLINICAL MEDICINEАртериальная ригидность у пациентов с острым коронарным синдромом без стойкого подъема сегмента ST в сочетании с хронической болезнью почек и артериальной гипертензией и ее коррекция на фоне антигипертензивной терапииArterial stiffness in patients with acute coronary syndrome without persistent ST segment elevation combined with chronic kidney disease and arterial hypertension and its correction with antihypertensive therapyhttps://orcid.org/0000-0002-2913-493XПрибыловСергей АлександровичPribylovSergey A.

д-р мед. наук, профессор, зав. кафедрой внутренних болезней ИНО, КГМУ, г. Курск

Dr. Sci. (Med.), Professor, Head of the Department of Internal Medicine, KSMU, Kursk, Russian Federation

pribylov_serg@mail.ruhttps://orcid.org/0000-0001-8820-6182ЯковлеваМаргарита ВалерьевнаYakovlevaMargarita V.

аспирант кафедры внутренних болезней ИНО, КГМУ, г. Курск

post-graduate student at the Department of Internal Medicine, KSMU, Kursk, Russian Federation

ya.yakovlevamargarita@yandex.ruhttps://orcid.org/0000-0002-4545-9339ПрибыловВладислав СергеевичPribylovVladislav S.

студент, КГМУ, г. Курск

student, KSMU, Kursk, Russian Federation

pribylov.vlad@mail.ruhttps://orcid.org/0000-0001-7656-2921БарбашинаТатьяна АнатольевнаBarbashinaTatiana A.

канд. мед. наук, доцент, доцент кафедры внутренних болезней ИНО, КГМУ, г. Курск

Cand. Sci. (Med.), Associate Professor of the Department of Internal Medicine, KSMU, Kursk, Russian Federation

blekas33@yandex.ruhttps://orcid.org/0000-0001-6120-6748ЛеонидоваКристина ОлеговнаLeonidovaKristina O.

студент, КГМУ, г. Курск

student, KSMU, Kursk, Russian Federation

k_leonidova@list.ruhttps://orcid.org/0000-0001-6788-518XПрибыловаНадежда НиколаевнаPribylovaNadezda N.

д-р мед. наук, профессор, профессор кафедры внутренних болезней ИНО, КГМУ, г. Курск

Dr. Sci. (Med.), Professor, Professor of the Department of Internal Medicine, KSMU, Kursk, Russian Federation

pribylova_nadezda@mail.ruКурский государственный медицинский университет (КГМУ)РоссияKursk State Medical University (KSMU)Russian Federation2022290320222511927Copyright © Прибылов С.А., Яковлева М.В., Прибылов В.С., Барбашина Т.А., Леонидова К.О., Прибылова Н.Н., 20222022Прибылов С.А., Яковлева М.В., Прибылов В.С., Барбашина Т.А., Леонидова К.О., Прибылова Н.Н.Pribylov S.A., Yakovleva M.V., Pribylov V.S., Barbashina T.A., Leonidova K.O., Pribylova N.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.kursk-vestnik.ru/jour/article/view/991

Цель: изучить состояние артериальной жесткости у пациентов, перенесших острый коронарный синдром без подъема сегмента ST (ОКСбпST), имеющих артериальную гипертензию (АГ) и хроническую болезнь почек (ХБП) 2-3А стадии, а также оценить способность антигипертензивной терапии ингибитором ангиотензинпревращающего фермента периндоприлом и антагонистом рецепторов ангиотензина лозартаном уменьшать жесткость артерий у данных пациентов. Материалы и методы. Обследовано 44 пациента с ОКСбпST в сочетании с ХБП 2-3А стадии, АГ (1-я группа). Группы сравнения: больные с ОКСбпST, АГ с нормальной функцией почек (2-я группа, n=27) и 3-я группа (n=44) больных с хронической ИБС, АГ и ХБП. Больные 1-й группы разделены на 2-е подгруппы, которые принимали периндоприл или лозартан. Оценивали параметры жесткости сосудистой стенки (скорость распространения пульсовой волны (СРПВ), сердечно-лодыжечный сосудистый индекс (СЛСИ), лодыжечно-плечевой индекс (ЛПИ)), индекс аугментации в аорте (AI), центральное систолическое и пульсовое аортальное давление (цСАД, цПАД), периферическое артериальное давление (АД), расчетную скорость клубочковой фильтрации (СКФ). Результаты. У пациентов с ОКСбпST в сочетании с ХБП 2-3А стадии и АГ были достоверно выше цПАД, AI, СРПВ, СЛСИ, чем у больных 2-й группы. За 3 месяца комплексной терапии с периндоприлом наблюдалось снижение СРПВ, цСАД, цПАД, AI. Не было достоверных различий в эффектах периндоприла и лозартана по влиянию на периферическое и центральное давление, состояние функции почек, параметры артериальной жесткости. Заключение. Пациенты с ОКСбпST, страдающие АГ и ХБП 2-3А стадии, отличаются более выраженной артериальной жесткостью в сравнении с аналогичными больными с нормальной СКФ. Антигипертензивная терапия с применением периндоприла и лозартана позволяет достичь целевых уровней периферического АД, значимо снизить центральное аортальное давление и

Objective: to study arterial stiffness in patients with acute coronary syndrome without ST elevation, who have hypertension (AH) and stage 2-3A chronic kidney disease (CKD) and to assess the ability of angiotensin-converting enzyme inhibitor perindopril and angiotensin receptor antagonist losartan to reduce arterial stiffness in these patients. Materials and Methods. We studied 44 patients with ACS without ST elevation combined with CKD stage 2-3A, AH (the 1st group). The comparison groups were the ACS without ST segment elevation, AH patients with normal renal function (the 2nd group, n=27) and the 3rd group (n=44) of patients with chronic CHD, AH and CKD. Group 1 patients were divided into 2 subgroups taking perindopril or losartan. The parameters of vascular wall stiffness (pulse wave velocity (PWV), cardio-ankle vascular index (CAVI), ankle brachial index (ABI), aortic augmentation index (AI), central systolic and pulse aortic pressure, peripheral blood pressure (BP), estimated glomerular filtration rate (GFR) were assessed.) Results. The patients with ACS without ST elevation combined with 2-3A stages of CKD and AH had a significantly higher cPAP, AI, PWV, and CAVI than the patients of the 2nd group. During 3 months of complex therapy with perindopril, a decrease in PWV, cSAP, cPAP, AI was observed. There were no significant differences in the effects of perindopril and losartan on peripheral and central blood pressure, on renal function, on arterial stiffness parameters. Conclusion. Patients with AH and CKD stage 2-3A have more pronounced arterial stiffness compared to similar patients with normal GFR. Antihypertensive therapy with perindopril and losartan allows to reach target levels of peripheral BP, significantly reduce central aortic pressure and improve elastic properties of the arterial vascular wall.

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The authors declare that there are no conflicts of interest present.