Abstract:
Object: to identify factors that limit the effectiveness of pharmacotherapy of
hypertension (HT) with comorbid coronary artery disease (CAD) in elderly obese patients by
determining laboratory and spectroscopy features related to inflammation.
Material and methods: 60 patients (68.2 ± 5.9 y.o.) were observed and treated in
Internal Medicine Department of University Clinic of Odessa National Medical University.
Patients were divided into 2 groups. The 1st group included patients (n = 30) with body mass
index (BMI) ≤25 kg/m2, HT and co-morbid CAD; the 2nd group (n = 30) - patients with
BMI≥30 kg/m2, HT and with co-morbid CAD. For each patient’s group antihypertensive
combination of Lisinopril and Bisoprolol was prescribed. The Laser correlation spectroscopy
(LCS) was a special method for investigation.
Results: before pharmacotherapy (PT) in both groups according to LCS 11-150 nm
particles are prevailing. But in obese patients 75th percentile of 31-70 nm particles exceeds
that one in non-obese group (56.7% vs 30.5%). During PT systolic blood pressure (SBP) value normalized in the patients of 1st group (without obesity), while in the obese patients (2nd
group) SBP remained above target level. Creatinine level increased in patients of 1st group
(without obesity) by 16.5 μmol / L (p <0.05) with a decrease in GFR by 17.1 ml/min/1.73 m2
(P <0.05). LCS data during PT show increase of 11-30 nm and decrease of 75-150 nm
particles in non-obese patients, while in obese patients 71-150 nm particles are prevailing and
150 nm particles have appeared (p<0.05).
Conclusions: 1. In elderly hypertensive patients with concomitant CAD, obesity is a
factor limiting the effectiveness of complex antihypertensive therapy. 2. An increase of
proportion of allergic-directed and appearance of autoimmune-directed homeostatic shifts in
serum according to LCS are associated with a decrease of antihypertensive therapy efficacy in
elderly hypertensive patients with CAD and obesity. 3. In hypertensive non-obese patients
with CAD under the influence of complex antihypertensive therapy deteriorating of renal
function is observed while in obesity renal function is not changed. 4. Homeostatic changes
revealed in the second group by LCS values probably reflect manifestation of low grade
inflammatory process caused by excessive activity of adipose tissue.
