The features of arterial hypertension combined with connective tissue dysplasia in family doctor practice

Authors

  • Ye.Kh. Zaremba Danylo Halytskyi Lviv National Medical University, Lviv, Ukraine,
  • N.O. Rak Danylo Halytskyi Lviv National Medical University, Lviv, Ukraine,
  • O.V. Zaremba-Fedchyshyn Danylo Halytskyi Lviv National Medical University, Lviv, Ukraine,

DOI:

https://doi.org/10.22141/2306-2436.6.3.2017.123485

Keywords:

артеріальна гіпертензія, дисплазія сполучної тканини, методи обстеження

Abstract

Background. The combination of arterial hypertension (AH) and connective tissue dysplasia (CTD) is one of the underdeveloped issues. CTD is accompanied by violations of the vessel structure and functions contributing to the development of early atherosclerosis and cardiovascular complications. Patients with AH combined with CTD often experience violations of the heart rhythm and conduction, widespread changes in the organs of vision, internal organs, as well as musculoskeletal system. The purpose of the study was to improve the diagnosis and treatment of AH combined with CTD, based on the clinical course study, the severity of external and internal symptoms of CTD, blood lipid spectrum, acute phase indices, uric acid and instrumental examination methods. Materials and methods. A clinical study was conducted and included 75 patients with AH stage II degrees 1–3 with CTD manifestations, the average age of which was 63.5 ± 4.2 years. The patients were on inpatient treatment in the cardiology department of Lviv Emergency Hospital.The methods of the study included clinical (examination, palpation, percussion, auscultation), laboratory (blood lipid profile, C-reactive protein, seromucoids and uric acid), instrumental (electrocardiography, echocardiography, daily blood pressure monitoring, esophagogastroduodenoscopy, ultrasound examination of the internal organs and vessels of the lower extremities, ultrasound duplex examination of the carotid and vertebral arteries, X-ray examination of the musculoske­letal system), consultations of an ophthalmologist, neurologist, traumatologist, dentist. Diagnosis of undifferentiated CTD was determined by methodology of T.M. Kadurina et al. (2009). The diagnostic factor calculation for each sign of dysplasia was performed according to the method developed by V.M. Yakovlev et al. (2008). The patients were divided into 3 groups: group 1 — 12 persons with AH stage II degree 1; group 2 — 26 individuals with AH stage II degree 2; group 3 — 30 patients with AH stage II degree 3. Control group — 7 patients with AH stage II degrees 1–3 without CTD manifestations. Results. The comparative analysis of the patients with AH was performed. There were external and internal connective tissue symptoms in 90.67 % of cases, there were no CTD manifestations in 9.33 % of cases. Group 3 patients had more CTD external and internal phenotypic signs in comparison with groups 1 and 2 that predict the severity of the clinical course of the disease. Conclusions. There is a significant proliferation of CTD in patients with AH, while, the more signs of CTD are observed, the heavier AH clinical course. The common changes are seen in the cardiovascular system, the organs of vision, internal organs and the musculoskeletal system in patients with AH associated with CTD, as compared to a group of AH patients without CTD. When comparing the groups of patients, the higher rates of inflammatory process activity and the lipid blood spectrum are observed in patients with AH and CTD. The timely detection of AH combined with CTD, systematic dispensary supervision of the patients, the implementation of measures aimed at improving the connective tissue structure and function, correction of immune deficiency can improve the course of this pathology.

References

Державна служба статистики України: Демографічна та соціальна статистика // Охорона здоров’я. Захворюваність населення (за даними Міністерства охорони здоров’я): http://www.ukrstat.gov.ua/. — 2017.

Коваленко В.М., Корнацький В.М. Проблема здоров’я і тривалості життя в сучасних умовах. — К., 2017.

Земцовский Э.В. Диспластические фенотипы. Диспластическое сердце (Аналитический обзор). — СПб.: Ольга, 2007. — 80 с.

Кадурина Т.И. Наследственные коллагенопатии: клиника, диагностика, лечение, диспансеризация. — СПб.: Невский диалект, 2000. — 271 с.

Кардиологические аспекты дислазии соединительной ткани у взрослых / Н.Я. Доценко, С.С. Боев, И.А. Шехунова, Л.В. Герасименко, В.О. Дедова. — Запоріжжя, 2012. — 96 с.

Строева Ю.И., Чурилова Л.П. Системная патология соединительной ткани. Руководство для врачей. — ЭЛБИ-СПб., 2014. — 368 с.

Воловар О.С. Фенотипічні особливості дисплазії сполучної тканини у хворих із захворюваннями скронево-нижньощелепного суглоба // Український медичний журнал. — 2013. — № 2. — С. 188-192.

Дєдова В.О. Ознаки дисплазії екстракраніальних артерій у хворих на артеріальну гіпертензію // Український терапевтичний журнал. — 2012. — № 2. — С. 73-76.

Проявления неклассифицированной дисплазии соединительной ткани в зависимости от возраста. Прогноз / Доценко Н.Я., Герасименко Л.В., Боев С.С. и др. // Український ревматологічний журнал. — 2012. — № 1. — С. 19-23.

Веighton P., Graham R., Bird Y. Hipermobility of joins. — Berlin, 1983. — 199 р.

Wynne-Davis R. Acetabular dysplasia and familial joint laxity: two etiological factors in congenital dislocation of the hip // Bone Joint Surg. — 1970. — Vol. 52. — Р. 704-716.

Issue

Section

General practice - family medicine