Journal of Nutritional Therapeutics, 2015, 4, 41-49 41 E-ISSN: 1929-5634/15 © 2015 Lifescience Global Oral L-Arginine Supplementation Effects on Cardiometabolic Factors in Hypertensive Patients with Rheumatoid Arthritis and its Relationship with Body Mass Index Olexandr Kuryata * and Oksana Sirenko State Establishment, Dnipropetrovsk Medical Academy of Health Ministry of Ukraine, Department of Hospital Therapy #1 and Occupational Diseases, Dzerzhynskogo str. 9, 49044, Dnipropetrovsk, Ukraine Abstract: Hypertension and rheumatoid arthritis are regarded as a conditions associated with higher risk for cardiovascular disease. As known endothelial dysfunction is an early pathophysiological feature and an independent predictor cardiovascular disease. L-arginine is the amino acid with potential to improve endothelial function and is expected to play a role in the prevention or treatment of cardiovascular disease. In addition, data exists that L-arginine aspartate can reduce insulin resistance. We aimed to evaluate the effects of oral L-arginine supplementation on cardiometabolic factors by determining endothelial function, insulin resistance, adiponectin level in hypertensive patients combined with rheumatoid arthritis and its relationship with body mass index. 69 females with mean age – 54 [50,3; 61,5] years were enrolled. The 1 st group made up 29 patients with hypertension combined with rheumatoid arthritis, 2 nd group – 20 patients with rheumatoid arthritis, 3 rd group – 20 patients with hypertension. In the endpoint patients were randomized to study subgroups patients, which received L-Arginine aspartate 30 ml/day during 4 weeks in addition to standard treatment, and control subgroups – received only the standard treatment. The levels of total cholesterol, triglycerides, C-reactive protein, serum creatinine, body mass index, body area index were determined. Insulin resistance, adiponectin level, endothelial-dependent flow mediated vasodilatation of brachial artery were measured at baseline and after 4 weeks. In patients with hypertension combined with rheumatoid arthritis identified a significant increase in insulin levels, insulin resistance, adiponectin, which were associated with cardiovascular risk, abdominal obesity, inflammatory activity levels. Oral supplementation of L-arginine causes multiple beneficial effects on the complex of cardiometabolic factors including: endothelial dysfunction, peripheral insulin resistance, adiponectin level in hypertensive patients with rheumatoid arthritis, mainly in obesity case. With the correction of endothelial function were established more significantly changes in the investigated parameters. Keywords: L-arginine, endothelial dysfunction, insulin resistance, adiponectin, obesity. 1. INTRODUCTION Improvements in rheumatoid arthritis (RA) treatments have resulted in increases in median life expectancy for this persons. Older RA patients now face the same medical conditions associated with aging in the general population, including cardiovascular disease (CVD) [1]. On the other hand, RA should be regarded as a condition associated with higher risk for CV disease and the key feature explaining this increased CV risk seems to be inflammation [2, 17]. Therefore, experts EULAR in 2010 published recommendations for management of patients with cardiovascular risk in RA [2]. Hypertension (HT) is quantitatively the most important modifiable risk factor for CVD seems highly prevalent in RA. The frequency of hypertension in RA varies from 18 to 70.5% according to different data [3]. It was noted in RA patients frequent (46%) and early formation of isolated systolic HT [4, 5], the most unfavorable in terms of cardiovascular complications, *Address correspondence to this author at the State Establishment, Dnipropetrovsk Medical Academy of Health Ministry of Ukraine, Department of Hospital Therapy #1 and Occupational Diseases, Dzerzhynskogo str. 9, 49044, Dnipropetrovsk, Ukraine; Tel: +3 8056 713-53-34; Fax: +3 8056 713-53-34; E-mail: gt1@dsma.dp.ua which is higher than prevalence in general population [6]. According to these facts cardiovascular risk management in HT patients combined with RA seems to be important for the fatal cardiovascular events prevention. Limited predictive value of traditional factors in HT patients in combination with RA, and the inconsistency of their impact, complexity of verification of atherosclerotic vascular lesions in RA necessitates the introduction into clinical practice of additional markers of cardiovascular risk and finding ways to influence them [7]. The cardiometabolic syndrome, an interesting constellation of cardiovascular, renal, metabolic, prothrombotic, and inflammatory abnormalities, widely discussed in the recent literature. Co-morbidities common in RA, such as insulin resistance, dyslipidaemia, adipose tissue metabolic disorders and obesity [8,9,18] have been shown to associate with essential HT and cardiometabolic syndrome in the general population [10, 19]. Obesity is highly prevalent in RA especially abdominal obesity. It is now recognized that adipose tissue is dynamic and metabolically active organ that secretes a number of bioactive molecules called adipokines [11], which may play a role in the development of atherogenesis in