RESUMEN
OBJECTIVE: Introduction:Changes in the cardiovascular system can be divided into 2 groups due to the connective tissue dysplasia (CTD) and changes in the circulatory system, caused by pathological processes that arose on the basis of the connective structures failure. One of the risk factors of arterial hypertension (AH) remaining insufficiently studied is collagen pathology - nondifferentiated connective tissue dysplasia (NCTD). The presence of connective tissue in all organs and systems, the common origin of smooth muscles, blood and lymph from mesenchyma leads to dysplastic changes in any organ and system. NCTD is morphologically characterized by changes in collagen, elastic fibrils, glycoproteins, proteoglycans and fibroblasts, which are based on hereditary mutations of genes encoding the synthesis and spatial organization of collagen, structural proteins and protein-hydrocarbon complexes, enzymes and cofactors to them. The aim was to study external and internal phenotypic signs of CTD, indicators of blood lipid spectrum, acute phase reactions and uric acid in patients with hypertension associated with CTD. PATIENTS AND METHODS: Materials and methods: The study implied examination of 52 patients (19 women and 33 men) with AH of the 2-nd stage from 1-st to 3-rd degrees and CTD manifestations, which were on inpatient treatment in the cardiology department of the Lviv City Communal Clinical Emergency Hospital. The average age of patients was 61.14 ± 2.58 years. Patients were divided into 3 groups depending on the degree of hypertension. The first group (n = 5) included patients with AH of the 1-st degree, the second (n = 28) - with AH of the 2-nd degree, the third (n = 19) - with AH of the 3-rd degree. The control group consisted of 25 practically healthy persons. Patients underwent checkup, palpation, percussion, auscultation, laboratory examinations (blood lipid spectrum, CRP, serumukoid content and uric acid), instrumental studies (ECG, echocardiography, DBPM, ultrasound examination of the internal organs and lower limbs vessels, ultrasound examination of the sleep and vertebral arteries, X-ray examination of the bone and articular system), consultation of an ophthalmologist, a neuropathologist, a traumatologist and a dentist. RESULTS: Results: In a comparative analysis between the control group and patients with stage ÐÐ hypertension of 1-3 grades, in 84.6% cases external and internal CTD signs were observed, and in 15.4% cases there were no manifestations. In applying the diagnostic criteria for assessing signs of CTD and stigmata of dysebryogenesis, different numbers of points were defined depending on the severity of the AH. The highest quantity of points was found in patients of the 3-rd group (30,8 ± 0,81), which indicates a significant presence of external signs of CTD in comparison with the 1-st and 2-nd groups of patients (25.2 ± 1.38 and 26.7 ± 0.72), respectively. CONCLUSION: Conclusions: The external and internal phenotypic signs of CTD of medium and severe expressiveness degree were revealed, however, most commonly they were observed in patients with hypertension of grade 3. The presence of positive correlations between the levels of TC, HDL-C, LDL-C, AC, UA and TG indicates its direct role in the pathogenesis of hypertension, and the combination with CTD complicates the underlined pathology. Screening of the studied indicators can improve the prognosis of the course and development of cardiovascular complications.
