Assessment of the status of the sympathoadrenal system in patients with essential hypertension combined with diabetes mellitus type 2 and nephropathy on the background of treatment nebivolol

Author(s):  N.Y.Kryvonos , M. Gorky Donetsk national medical university, Donetsk, Donetsk People's Republic, voloskova81@mail.ru

V.V. Kolomiyets, Dr., Prof., M. Gorky Donetsk national medical university, Donetsk, Donetsk People's Republic, vvkolomiyets@i.ua

Issue:  Volume 42, № 2

Rubric:  Internal diseases

Annotation:  Objective: to assess the state of the sympathetic adrenal system and its role in the disturbance of hemodynamics and renal function in patients with EH in combination with type 2 diabetes and the possibility of correcting these disorders by including nebivolol in treatment. We examined 32 patients with essential hypertension stage II in combination with diabetes mellitus type 2 in the compensation. 30 patients with essential hypertension stage II and I-II degree made up 1 comparison group. The the 2nd comparison group consisted on 30 patients with diabetes mellitus type 2. Thirty healthy volunteers were also examined. Patients in the main group (32 patients) and patients with essential hypertension were assigned nebivolol at a dose of 5 mg/day during 12 weeks. The activity of the sympathetic adrenal system was studied by analysis of catecholaminuria and heart rate variability. The synthesis of nitric oxide was evaluated with the serum concentration of nitrogen oxide metabolites and their daily urinary excretion. After 12 weeks of taking nebivolol in patients in the main group, and in the 1st comparison group urinary epinephrine excretion significantly (p < 0,05) has decreased. Norepinephrine renal excretion in patients with essential hypertension and diabetes type 2 after 3 months of nebivolol intake significantly decreased, the concentration of nitric oxide metabolites in serum and their urinary excretion significantly increased. After 3 months of nebivolol intake, there was a significant decrease in the LF marker of sympathetic activity in patients in the mian and the 1st comparison groups. Analysis of HF values reflecting the severity of parasympathetic influence showed that after 12 weeks of nebivolol administration a statistically significant increase in parasympathetic activity was achieved only in the main group. The conducted study showed that nebivolol intake in a dose of 5 mg per day in patients with essential hypertension on the background of diabetes mellitus type 2 decreased the sympathetic tone and increased the parasympathetic tone, and activated NO production in central and renal circulation.

Keywords:  diabetic nephropathy, sympatho-adrenal system, nebivolol, essential hypertension.

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