Rheumatoid arthritis (RA) is recognized as an independent cardiovascular risk factor. The presence of arterial hypertension in patients with rheumatoid arthritis is associated with an unfavorable prognosis; the combination of diseases significantly interrelates to the course of each one. An important issue is the selection of complex therapy to correct diastolic dysfunction and left ventricular remodeling processes.
The study involved 60 patients with RA in combination with hypertension, who were divided into two groups: group I and group II of 30 people each. All patients received basic therapy for RA, NSAIDs and GK. The control group III included 30 almost healthy people. Patients of group I additionally received ramipril 10 mg daily and amlodipine 5–10 mg daily.
All patients from group I also received atorvastatin 20 mg daily and metabolic therapy of Mildronate 5 ml 0.5 g/5 ml intravenous drip per 200 ml sodium chloride solution 0.9 % once a day for ten days, followed by a switch to capsules Mildronate 250 mg at a dose of 500 mg per day for 3 months. After repeated examination three months later, the patients of group I showed a decrease in myocardial mass index by 8.86 % (р < 0.05), decreased size of the left atrium by 5.52 % (p < 0.05), improved diastolic function: 13.33 % of patients showed normalization, and 6,67 % had type II diastolic dysfunction transition to type I (p < 0.05). Also in the patients of group I with fluid in the pericardial cavity there was a decrease in the final diastolic size of the circular rim of the fluid by 46.6 % (p < 0.05). Patients in group II showed an increase in myocardial mass index by 3.33 %, size of the left atrium by 8.68 % (p < 0.05) and the number of patients with diastolic dysfunction increased by 10 % (p < 0.05). The size of the circular rim of fluid in the patients of group II with fluid in the pericardial cavity increased by 6.67 % (p < 0.05).
It can be concluded that such a scheme is relevant and can be recommended in order to select rational complex therapy in patients with RA in combination with hypertension.
2. Zegkos Т, Kitas G, Dimitroulas T. Cardiovascular risk in rheumatoid arthritis: assessment, management and next steps. Therapeutic Advances in Musculoskeletal Disease. 2016; 3: 86–101.
3. McMaster W, Kirabo A, Madhur M, Harrison D. Inflammation, immunity, and hypertensive end-organ damage. Circ Res. 2015; 116:1022-1033.
4. Yndestad A, DamasJ, Oie E, Ueland T, Gullestad L, Aukrust P. Role of inflammation in the progression of heart failure. Curr Cardiol Rep. 2007; 9:236-241.
5. Sharma A, Kaushik R, Kaushik RM, Kakkar R. Echocardiographic evaluation of diastolic dysfunction in rheumatoid arthritis—a case–control study. Modern Rheumatology. 2015; 25(4):552-557.
6. Mokotedi L, Gunter S, Robinson C, Norton R, Woodiwiss AG, Tsang L, Dessein PH, Millen AM. The Impact of Different Classification Criteria Sets on the Estimated Prevalence and Associated Risk Factors of Diastolic Dysfunction in Rheumatoid Arthritis. Journal of Rheumatology. 2017. Retrieved from: https://www.hindawi.com/journals/ijr/2017/2323410/ ID 2323410, 13 pages.
7. Rexhepaj N, Bajraktari G, Berisha I, Beqiri A. Left and right ventricular diastolic functions in patients with rheumatoid arthritis without clinically evident cardiovascular disease. International Journal of Clinical Practice. 2016; 60(6):683-688.
8. Kirilova IG, Novikova DS, Popkova TV, Gorbunova NU, Markelova IE, Korsakova YO, Volkova AE, Aleksandrova EN, Novikov AA, Fomichova OA. [Diastolic dysfunction of the left and right ventricles in patients with early rheumatoid arthritis prior to the appointment of basic anti-inflammatory therapy]. Therapeutic archive. 2015; 87(5):16-23.