[Structural-functional changes of myocardium and hemodynamic disturbances in patients with metabolic syndrome: contribution of arterial hypertension in formation of total coronary risk].

AIM: To assess in the aggregate hemodynamic peculiarities and changes of the myocardium as well as contribution of hypertension in formation of coronary risk in metabolic syndrome (MS). MATERIAL AND METHODS: Patients (n=290) with hypertension of I-II degree and duration > or = 5 years were subjected to laboratory (parameters of lipid spectrum, glucose and insulin levels) and instrumental (24-hour blood pressure monitoring, echocardiography) examination. Criteria of MS were fasting insulin > 18 mcU/ml and/or glucose/insulin ratio or = 140/90 mm Hg; triglycerides > or = 200 mg/dl and/or high density lipoprotein cholesterol 25 kg/m(2) with waist/hip circumference ratio > or = 0.95 (for men) or > or = 0.80 (for women); impaired glucose tolerance according to WHO criteria. PROCAM model was used for calculation of total coronary risk. RESULTS: 37% of patients with hypertension had all components of MS. Hypertension took third place among contributors to formation of total coronary risk with input of 20%. Diastolic BP positively correlated with triglycerides, total cholesterol, index of insulin resistance and parameters of abdominal obesity. Mean 24 hour systolic and pulse BP in patients with MS were significantly higher than in a group of patients with hypertension without metabolic disturbances. Patients with MS had thicker left ventricular posterior wall and interventricular septum what was associated with increased end-systolic and end-diastolic dimensions as well as myocardial mass of the left ventricle. CONCLUSION: In patients with MS 24 hour BP profile is impaired at the account of high pulse BP and lack of nocturnal lowering of systolic and diastolic BP and is associated with concentric left ventricular hypertrophy.