Clinical significance of insulin resistance and B-type natriuretic peptide in structural remodeling of the left ventricle in hypertensives with metabolic syndrome
DOI:
https://doi.org/10.32782/2415-8127.2022.66.9Keywords:
metabolic syndrome, insulin resistance, B-type natriuretic peptide, remodeling, left ventricle.Abstract
Introduction. The metabolic syndrome is a combination of clinical (arterial hypertension, abdominal obesity) and metabolic (insulin resistance, dyslipidemia) disorders that are risk factors for cardiovascular complications. Among the numerous factors of structural remodeling of the myocardium, arterial hypertension, hyperinsulinemia and disorders of sodium-urethic peptide metabolism have an important pathogenetic value. The aim of the study is to evaluate the influence of insulin resistance in relation to B B-type natriuretic peptide (BNP) on indicators of structural remodeling of the left ventricle in hypertensives with metabolic syndrome. Materials and methods. Were examined 124 patients with arterial hypertension with metabolic syndrome. Endogenous insulin levels were determined under the conditions of an oral glucose tolerance test, BNP level in blood were measured and echocardiography was performed. Depending on the level of endogenous insulin, patients were divided into three groups. Research results and their discussion. In hypertensives with metabolic syndrome were found changes to varying degrees in the structural and functional indicators of the left ventricle, depending on the type of insulinemia. The presence of reactive and spontaneous hyperinsulinemia in hypertensives with metabolic syndrome contributes to the development of predominantly concentric myocardial hypertrophy with an increase in left ventricular myocardial mass index by 1.7 and 1.8 times, the occurrence of diastolic dysfunction of the left ventricle type I and an increase in BNP level in the blood > 120 pg / ml. Were revealed direct correlations between the fasting endogenous insulin level and BNP. The maximum value of BNP is observed in patients with spontaneous hyperinsulinemia and heart failure. Conclusions. 1. In hypertensives with metabolic syndrome, the most pronounced changes in indicators of structural remodeling of the left ventricle were characteristic of reactive and spontaneous hyperinsulinemia. 2. A direct correlation between the left ventricular myocardial mass index and the level of endogenous insulin was revealed as the severity of insulin resistance increases with the development of predominantly concentric hypertrophy and the emergence of left ventricular diastolic dysfunction, which is associated with an increased risk of cardiovascular complications. 3. In hypertensives with metabolic syndrome, insulin resistance is accompanied by an increased level of BNP in the blood, which is associated with the occurrence and progression of heart failure and the activation of antihypertrophic processes to reduce myocardial remodeling.
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