CORRECTION OF ENDOTELIAL DYSFUNCTION IN PATIENTS WITH ARTERIAL HYPERTENSION WITH RHEUMATOID ARTHRITIS
About the author:
Fushtey I. M., Sid’ E. V., Ryndina N. G.
CLINICAL AND EXPERIMENTAL MEDICINE
Type of article:
The aim of the study was to investigate endothelial function in patients with arterial hypertension with rheumatoid arthritis and to evaluate the clinical efficacy of metabolic therapy using meldonium, and L-arginine aspartate for endothelial dysfunction. Object and research methods: 93 patients with arterial hypertension II stage (grades 1 and 2) with rheumatoid arthritis were studied, mean age 56 (51; 61) years, activity on the DAS 28 scale 4,64 (4,24; 4,88) points, and 45 patients with arterial hypertension II stage (grades 1 and 2), mean age 54 (51; 58) years. To study the endothelial function, a teste with reactive hyperemia on the brachial artery was used, the concentration of ADMA and the final stable metabolites of nitric oxide in the serum were determined at the beginning of the study, and three months later. All patients with arterial hypertension in combination with rheumatoid arthritis were taking ramipril 10 mg per day, amlodipine 5 (5; 10) mg per day, atorvastatin 20 mg, basic therapy for the treatment of rheumatoid arthritis and metabolic therapy which includes meldonium, and L-arginine aspartate. Conclusions. In patients with arterial hypertension in combination with rheumatoid arthritis, the median of the total nitrogen metabolites 15 (12,5; 18) μmol/l was lower by 11,76 % compared to the median of patients with arterial hypertension 17 (15, 20) μmol/l and the ADMA median 0,78 (0,68; 0,88) μmol/l was higher by 21,79 % compared to the ADMA 0,61 (0,58; 0,64) μmol/l of patients with arterial hypertension (p < 0,01). Inverse correlations were established between the indicators of total nitrogen metabolites and ADMA R = – 0,82 (p < 0,01), the values of endothelium-dependent vasodilation and ADMA R = – 0,79 (p < 0,01). In patients who took L – arginine aspartate the median of the endothelium-dependent vasodilation index 16,24 (12,42; 27,18) % was significantly higher by 9,1 % compared with the endothelium-dependent vasodilation index 14,77 (10,17; 23,56) % patients who took meldonium, and by 23,3 % higher compared with endothelium-dependent vasodilation index 12,46 (8,72; 16,11) % of patients without metabolic therapy (p < 0,05). The median of the total nitrogen metabolites 24,1 (19,8, 24) μmol/l was significantly higher by 12,03 % compared with 21,2 (19,1; 23) μmol/l of patients receiving meldonium, and by 17,84 % higher compared to 19,8 (17,5; 21) μmol/l in patients without metabolic therapy (p < 0,05). The median of the total nitrogen metabolites of patients who took L – argenine aspartate 24,1 (19,8; 24) μmol/l was significantly higher by 12,03 % compared with the median of patients who took meldonium 21,2 (19,1 23) μmol/l and by 17,84 % higher compared of patients without metabolic therapy 19,8 (17,5; 21) μmol/l (p < 0,05). ADMA median in patients who took L-arginine aspartate 0,63 [0,61; 0,73] μmol/l was significantly lower by 8,4% compared with the median of patients who took Meldonium 0,69 (0,62; 0,79) μmol/l and by 13,4 % lower compared with the median of patients without metabolic therapy ADMA 0,73 (0,64; 0,85) mmol/l (p < 0,05).
arterial hypertension, rheumatoid arthritis, endothelial dysfunction metabolic therapy.
- Braun J, Krüger К, Manger В. Cardiovascular Comorbidity in Inflammatory Rheumatological Conditions. Clin Geriatr Med. 2017;114:197-203.
- Dougados М, Soubrier М, Antunez А. Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA). Ann Rheum Dis. 2014;73:62-8.
- Hadi H, Carr S, Suwaidi J. Endothelial Dysfunction: Cardiovascular Risk Factors, Therapy, and Outcome. Vascular Health and Risk Management. 2015;1(3):183-98.
- Sibal L, Agarwal SC, Home PD, Boger RH. The Role of Asymmetric Dimethylarginine (ADMA) in Endothelial Dysfunction and Cardiovascular Disease. Curr Cardiol Rev. 2010;6:82-90.
- Şentürk T, Yılmaz N, Sargın G. Relationship between asymmetric dimethylarginine and endothelial dysfunction in patients with rheumatoid arthritis. Eur J Rheumato. 2016;3:106-8.
- Manuela F, Lucchino B, Conti F. Asymmetric Dimethyl Arginine as a Biomarker of Atherosclerosis in Rheumatoid Arthritis. Hindawi Mediators of Inflammation. [Internet]. 2018. Available from: https://doi.org/10.1155/2018/3897295
- Berezin AYe. Rol’ endotelial’noy disfunktsii v razvitii kardiovaskulyarnykh zabolevaniy: perspektivy farmakologicheskoy korrektsii donatorami oksida azota. Ukraуnskiy medichniy chasopis. 2015;5:50-4. [in Russiаn].
- Revmatoidniy artrit adaptovana klinichna nastanova zasnovana na dokazah: MOZ Ukraini № 263 vid 11.04.2014 r. [Internet]. Dostupno: www. moz.gov.ua [in Ukrainian].
Publication of the article:
«Bulletin of problems biology and medicine» Issue 4 Part 2 (154), 2019 year, 216-221 pages, index UDK 616.12-008.331.1: 616.72- 00277: [611.018. 74: 616-008] – 085