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CNAA / Theses / 2005 / June /

Clinical-hemodynamic and biochemical aspects at the patients with arterial hypertension and obesity and the influence of selective β-adrenoblocant Nebivolol


Author: Viorica Ochişor
Degree:doctor of medicine
Speciality: 14.00.06 - Cardiology and Reumatology
Year:2005
Scientific adviser: Valeriu Revenco
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution:
Scientific council:

Status

The thesis was presented on the 10 June, 2005
Approved by NCAA on the 22 September, 2005

Abstract

Adobe PDF document – 0.40 Mb / in romanian

Keywords

arterial hipertension, obesity, insulinresistance, dislipidemia, Nebivolol

Summary

It was examined 119 patients with arterial hypertension of I – II degree in association with obesity: 52 (43,7%) of them were males and 67 (56,3%) were women, both groups in age of 30 –65 years (the median age 49± 0,6 years).

The complex evaluation of patients established that the group of hypertensive patients in association with obesity wasn’t homogenous: in 52,9% of cases it was established insulin resistance (22,7% - diabetes mellitus type II; 12,6% - deteriorated tolerance to glucose; 17,6% - glicemic data were into normal limits in association with hyperinsulinemia) in 47,1% of cases weren’t observed any modifications of glicemic spectrum. Later on the patients were examined in function of insulin resistance.

The initial clinical-hemodynamic indices didn’t vary significantly in the patients’ groups with insulin resistance and without insulin resistance. It was observed a high frequency of obesity of abdominal type manifested with significantly big values of relations perimeter of waist of hip and perimeter of waist at the patients with insulin resistance meanwhile the body mass index didn’t vary significantly in both groups.

The presence of insulin resistance has been established at patients with arterial hypertension and obesity was associated more frequently with dislipidemia manifested with reduced contains of HDL-cholesterol and elevation of LDL-cholesterol and trigligerides, relations total cholesterol/HDL-cholesterol, LDL-cholesterol/HDL-cholesterol, the fact implying an increased index of aterogenity.

Seven risk factors of life style have been pointed out at patients with insulin resistance as follow: abusive nutrition, especially at late hours, exagerate liquid consumption, non- limited animal lipids ingestion, chronicle sleep deficit, alcohol abuse, non limited consumption of flour products and tobacco smoking.

It has been established that the antihypertensive effect of Nebivolol depends on treatment’s duration. Thus, the antihypertensive effect was established in conditions of acute test in 22,2% of cases, in treatment during one month – in 51,2% of cases and other 3 months in 58,1% of cases. The administration of Nebivolol in doze 5 mg during 3 months demonstrated a significant reduction of heart contractions frequency – with 13,0±0,7 contractipns/min (p<0,001); systolic arterial tension – with 18,3±0,6 mm Hg (p<0,001) and diastolic arterial tension – with 11,6±0,6 mm Hg (p<0,001) and the general labour’s volume increased during the test with physical effort with 154,9 Wt (p<0,01).