In recent years, the concept of “small vascular disease” has been distinguished, as causes of a decrease in coronary reserve and the appearance of myocardial ischemia, which is often observed with a combination of hypertension, obesity, hyperlipidemia, insulin resistance. This group of patients has an increased risk of coronary artery disease and / or myocardial infarction.
Much attention has recently been paid to systolic (“arteriosclerosis”) arterial hypertension (SAH). SAG is, by the definition of a WHO expert, a generic term used to describe all patients with high systolic blood pressure equal to or greater than 140 mmHg. Art. and diastolic blood pressure less than 90 mm Hg. Art. Systolic hypertension has been shown to be an independent risk factor for coronary artery disease, stroke, and other cardiovascular diseases.
The prevalence of SAG increases with age in both men and women, but is relatively rare in people under 45 years of age. In men and women older than 55 years, its frequency increases, and in women this growth is faster than in men. According to the Framingham study, isolated SAG is found in 14% of men and 23% of women over 65, and it accounts for 57% of all cases of AH in men and 65% in women.
In patients with isolated SAG, pulse pressure is increased, i.e. the difference between systolic and diastolic blood pressure. This is mainly due to the reduced ductility of the arteries, partly due to aging. The main mechanisms for the development of isolated SAH in the elderly are as follows: reduced arterial compliance, increased peripheral vascular resistance, changes in cardiac output, decreased plasma renin activity and a decrease in the activity of the sympathetic-adrenal system. Isolated SAH can also be caused by aortic insufficiency, atrioventricular dissociation (complete transverse heart block), Paget’s disease, aortic coarctation, severe anemia, and hyperthyroidism.
Diagnosis of “silent” myocardial ischemia, latent forms of cardiac rhythm disturbances is often difficult and requires additional examination methods: bicycle ergometry, ECG monitoring, myocardial scintigraphy on the background of physical activity and a test with dipyridamole. With the help of radionuclide ventriculography with labeled thallium and magnetic resonance imaging, it is possible to clarify the nature and extent of damage to the myocardium, the capillary bed and the coronary vessels.
In difficult cases, according to indications in connection with the upcoming surgical treatment (coronary artery bypass surgery, balloon replacement), coronarography is used to identify the localization of the injury. However, the high cost of diagnostic equipment limits its widespread use in clinical practice. Holter monitoring is one of the most commonly used in clinical practice methods for diagnosing mute ischemia. Anamnesis, patient complaints, objective data and general clinical research methods allow to diagnose arterial hypertension in patients with diabetes without using complex diagnostic methods.
Glycemic and glycated hemoglobin control, lipid screening, hemostasis indicators, microalbuminuria, glomerular filtration and fundus research are an integral part of early diagnosis and prevention of cardiovascular complications.
In the future, the creation of clinical genetic laboratories with the aim of studying the association of polymorphism of the corresponding genes. Studying the association of gene polymorphism with vascular complications in diabetic patients would allow one to assess the relative risk, to predict the development and progression of complications long before their clinical manifestations.