Blood pressure time load formation in patients with arterial hypertension without metabolic syndrome

Relevance . The study of the daily dynamics of blood pressure in arterial hypertension both on the basis of the daily index and on the basis of the time load is a relevant task, since, these indicators are associated in the literature with stable changes in the neurohumoral regulation of the cardiovascular system in arterial hypertension . The aim of the study was to compare data of the time load in patients with arterial hypertension , depending on the nocturnal blood pressure profile, with integrative indicators of the activity of the cardiovascular system in the form of a Circadian index, a structural point of blood pressure, double product. Materials and Methods. The study included 72 patients who were treated at the City Clinical Hospital No 13 in Moscow and signed a voluntary consent to participate in the research and the processing of personal data. Inclusion criteria: arterial hypertension. Exclusion criteria: metabolic syndrome, secondary forms of arterial hypertension and concomitant pathology. Depending on the daily index (DI10% and DI10%) patients were divided into 2 groups: 1 group (N= 32): patients with arterial hypertension without nocturnal decrease in blood pressure (non-dippers and night-pickers100%); Group 2 (N = 40): patients with arterial hypertension who had a nocturnal decrease in blood pressure (dippers and over dippers 100%). All patients and members of the control group (N=15) underwent daily monitoring of blood pressure (24-hour Arterial Blood Pressure Monitoring). The data were statistically processed to determine the 5% level of significance of differences (p0.05) (Students test). In the comparative analysis of integrative indicators at day and at night, a variance analysis was applied. Results and Discussion . As a result of the study, it was found that the values of Circadian Index for blood pressure vary depending on the type of night decrease in blood pressure and the blood pressure time load, while daily index and structural point of blood pressure remain on the same level as a reflection of the hemodynamic allostasis existing in both groups. Conclusion. Reflection of the allostatic load on hemodynamics is change of values of double product and of the structural point of blood pressure compared with the control group. These changes are not associated with the peculiarities of the nocturnal blood pressure profile in patients with hypertension without metabolic syndrome.

Indicators of ambulatory blood pressure monitoring in patients with essential hypertension of the 2-nd stage depending on the type of 24-hours blood pressure profile, the state of the left ventricular diastolic filling and endothelial function of vessels

Annotation. Arterial hypertension (AH) is one of the most important risk factors for the development of cardiovascular complications and mortality in the world and it has become a medical and social problem. The prevalence of hypertension will increase to 1.56 billion by 2025, making the disease a very serious problem. The severity of clinical manifestations and prognosis in patients with hypertension are determined not only by the degree of increase in blood pressure (BP) but also the damage to target organs. The load on the cardiovascular system caused by elevated BP leads to structural remodelling of the heart and vessels. The aim – to evaluate peculiarities of indicators of ambulatory blood pressure monitoring in patients with essential hypertension of the 2nd stage depending on the type of 24-hours blood pressure profile, the state of the left ventricular diastolic filling and endothelial function of the vessels and determine independent clinical and instrumental criteria of the 24-hours profile “dipper” and “non-dipper”. The study involved 110 patients (40 men and 70 women) with hypertension of the II-nd stage, hypertensive heart, chronic heart failure of the 0-I stage (average age was 54.19±0.89 years). The patients underwent 24-hour blood pressure monitoring, echocardiography and determination the thickness of the intima-media complex (IMCT) of the brachial artery, endothelium-dependent (EDVD) and endothelium-independent (EIVD) vasodilatation. For statistical analysis, arithmetic means (M), errors of mean values (m), t - Student's t test for paired measurements were calculated. Correlation ratios were evaluated by the method of linear correlation for parametric data and the method of Spearman’s rank correlation for nonparametric data. Paired group comparisons were performed by the nonparametric Mann-Whitney method. Wilcoxon test was used in the analysis of dependent samples. Step-by-step multifactor regression was used to identify independent criteria for daily blood pressure profiles. Two types of 24-hours profile of blood pressure – “dipper” and “non-dipper” were detected. The left ventricle diastolic dysfunction (LVDD) by type of relaxation disorder was observed in all “non-dipper” patients and most “dipper” patients. Patients with DD had higher levels of BP per 24-hours, day, night, corresponding the time indexes, the magnitude of the morning increase of systolic and diastolic blood pressure, more pronounced structural changes of the heart and vessels compared with patients with preserved diastolic filling of the LV(р<0,01). The duration of the hypertensive anamnesis (p=0.0002), the thickness of the posterior wall of the LV (p=0.002), the maximum speed of early diastolic filling of the LV (E) (p<0.0001), the LV ejection fraction (p=0.001), the index of the left atrium (p=0.008), the thickness of the intima-media complex of the brachial artery (p=0.013), increase of the diameter of the brachial artery in 90 s after compression (EDVD) (p<0.0001) and in 5 min after taking of nitroglycerin (EIVD) (p=0.009) were determined as independent clinical and instrumental criteria of the “dipper” and “non-dipper” profile. Insufficient the degree of the nightly decrease of the BP, higher magnitude of the morning increase of systolic and diastolic BP cause more hemodynamic pressure on target organs and lead to more significant pathological remodeling of the LV and vessels, disorders of the LV relaxation processes and endothelial dysfunction.

Blood pressure profiles in patients with arterial hypertension and obstructive sleep apnea in different age groups

Background. Obstructive sleep apnea (OSA) is frequently associated with hypertension (HTN), and about 50 % hypertensive patients have concomitant OSA. Episodes of transient upper airway obstruction affect the daily blood pressure profile, leading to nocturnal HTN. Although the general relationship between OSA and the daily blood pressure profile is known, the association between the frequency of various daily blood pressure profiles and OSA severity as well as the age-specific differences remain unknown. The aim of the study was to determine the daily blood pressure profiles in patients with HTN and OSA, depending on the OSA severity and age. Design and methods. The study included 236 HTN patients underwent treatment in the period from 2008 to 2021 years and were diagnosed with OSA by cardiorespiratory monitoring: 84 patients had mild OSA (apnea/hypopnea index (AHI) < 15 episodes/h), 46 patients — moderate OSA (15 ≤ AHI < 30 episodes/h), and 106 patients — severe OSA (AHI ≥ 30 episodes/h). The control group included 140 HTN patients without OSA. Both groups were divided into 3 age subgroups: younger than 45 years, 45–59 years and ≥ 60 years. At baseline, all patients underwent cardiorespiratory monitoring (“Kardiotekhnika‑07–3/12P”, Inkart, St Petersburg, Russia) and 24-hour blood pressure (BP) monitoring (BPLab, Nizhny Novgorod, Russia). Results. We found an association between the distribution of daily BP profiles and age, which differs from that in HTN patients without OSA. Non-dipper and night-peaker BP profiles are predominant in young and middle age. Among OSA patients, the severity of OSA was associated with the BP profiles only in the young and middleage groups. Unfavorable BP profiles (non-dipper and night-peaker) were more common in patients with severe OSA, which was not observed in elderly subgroup. In the elderly, compared to younger patients, the overdipper profile was the most common and its frequency was not associated with OSA severity. Conclusions. The study shows the relationship between the age of patients with HTN and OSA, the OSA severity and the distribution of daily BP profiles.

Hol van a normális és a kóros vérnyomás közötti határ, és mi a terápiás cél a cardiovascularis és a renalis betegségekben?

Összefoglaló. Az irodalmi adatok arra utalnak, hogy a systolés vérnyomás értékének emelkedése már 110–115 Hgmm-től együtt jár az atherosclerosissal összefüggő elváltozások kialakulásával is és ezzel együtt a cardiovascularis és a renalis funkció romlásával. Az összefüggés exponenciális, de mértékét az életkor jelentősen befolyásolja. A kezelés során az elérendő vérnyomás célértéke a jelenlegi adatok alapján 120–130 Hgmm között helyezkedik el a 18–65 év közötti populációban; idősebb korban – különösen 80 év felett – ennél magasabb, a 130 Hgmm alatti érték elérése nem reális, de talán nem is szükséges. A leghelyesebb az egyéni vérnyomásprofil meghatározása, és számos befolyásoló tényezőt is figyelembe kell venni a páciens legmegfelelőbb kezeléséhez. A populáció egészségének javításához és megőrzéséhez az egyik legfontosabb és leggyakoribb cardiovascularis kockázati tényezőt, a magas vérnyomást időben fel kell fedezni, amihez a vérnyomást rendszeresen szükséges ellenőrizni, és ezzel párhuzamosan kell végezni a prevenciót célzó tevékenységeket (nevelés, oktatás, szűrés, egészségtudatos életmód) is. Orv Hetil. 2021; 162(34): 1351–1361. Summary. The data in the literature suggest that the increase in the value of systolic blood pressure from 110–115 mmHg leads to the development of atherosclerotic process and to the deterioration of cardiovascular and renal function. The correlation is initially linear, then above 140–150 mmHg it is already exponential, but it is also related to the progression of the age. The systolic target for therapy is between 120–130 mmHg in the population aged 18–65; in older ages – especially over 80 years – it is higher and reaching the value below 130 mmHg is unrealistic, and may even be not necessary. It is the best to determine the individual treatment, taking into account the individual blood pressure profile and the factors influencing the patient. In order to improve and maintain the health of the population – in addition to unknown hypertension – it is necessary to regularly monitor blood pressure and apply the known preventive methods (education, training, screening, etc). Orv Hetil. 2021; 162(34): 1351–1361.

Influence of the Severity of Obesity on the Structure of the Daily Blood Pressure Profile and the Effectiveness of its Correction by Means of Physical Therapy Against the Background of Therapeutic Alliance at Various Levels

In recent years, obesity has become one of the most common non-communicable diseases, affecting the population around the world, regardless of age, gender, social status. Weight gain is associated with an increased risk of death from any cause, primarily from cardiovascular disease. The main clinical complication of obesity is arterial hypertension. Purpose: to determine the effect of the severity of obesity on the structure of the daily blood pressure profile and the effectiveness of its correction by means of physical therapy against the background of different levels of therapeutic alliance. Materials and methods. The study involved 213 people with obesity of I-III degree, diagnosed by body mass index. According to the results of the definition of the therapeutic alliance, they were divided into two groups. The comparison group consisted of individuals with a low level of therapeutic alliance who refused to actively participate in the program of weight loss. The main group consisted of patients with a high level of therapeutic alliance, they underwent a correction program using dietary and lifestyle modifications, therapeutic exercises, massage, acupuncture, psychocorrection lasting one year. The control group consisted of 32 people with normal body weight. Daily monitoring of blood pressure was carried out to determine its profile by the types "diрper", "non-dipper", "over-dipper", "night-peaker". Results. In patients with grade I-III obesity, changes in the structure of the daily profile of systolic and diastolic blood pressure were revealed: a decrease in the number of individuals with an optimal "diрper" profile, an increase - with unfavorable profiles "non-dipper", "over-dipper", "night-peaker" ", the number of which increased in direct proportion to the degree of obesity. The use of kinesiоtherapy against the background of a decrease in body weight as part of a physical therapy program allows to normalize the daily blood pressure profile. A low level of therapeutic alliance leads to unsatisfactory fulfillment or non-fulfillment of the recommendations provided (aimed at reducing body weight and increasing physical activity) in obese patients, which is associated with a lack of improvement in the functioning of the cardiovascular system in the context of normalizing the daily blood pressure profile. Conclusions. It is advisable to prescribe physical therapy means to correct the indicators of the daily blood pressure profile in patients with obesity of I-III severity, which will prognostically reduce the risk of cardiovascular accidents in them