Comparative characteristics of indicators of peripheral arterial and central aortic pressure, remodeling of the left ventricular myocardium in salt-sensitive and salt-resistant patients with arterial hypertension

Background. Changes in the vascular wall, in particular, an increase in its stiffness and an increase in pressure in the aorta, as well as hypertrophy of the left ventricular myocardium are factors that determine a poor prognosis in patients with arterial hypertension. At the same time, the peculiarities of changes in arterial stiffness indices and left ventricular myocardial remodeling in patients with different sensitivity to salt loading have not been adequately studied. Aim. To conduct a comparative analysis of the values of peripheral blood pressure and central aortic pressure, indicators of left ventricular myocardial remodeling in salt-sensitive and salt-resistant patients with arterial hypertension. Materials and methods. The study involved 180 patients with arterial hypertension: 96 men and 84 women. The median age was 59 years. Salt sensitivity test was performed according to V.I. Kharchenko. All patients underwent 24-hour blood pressure monitoring, echocardiography. Indicators of peripheral arterial pressure and central aortic pressure, remodeling of the left ventricular myocardium were determined. Results. According to the results of the test V.I. Kharchenko, 88 patients were classified as salt-sensitive, 92 as salt-resistant. After a salt sensitivity test in salt-sensitive patients, the main indicators of peripheral blood pressure and central aortic pressure exceeded those in salt-resistant patients in the daytime, at night, and throughout the day as a whole. In the group of salt-sensitive individuals, statistically more significant negative changes in echocardiographic parameters were recorded; a significant number of salt-sensitive patients were diagnosed with prognostically unfavorable variants of left ventricular myocardial remodeling. Conclusion. In salt-sensitive patients with arterial hypertension, compared with salt-resistant patients, there are higher values of both peripheral blood pressure and central aortic pressure, more significant negative changes in echocardiographic parameters with the formation of concentric hypertrophy and eccentric remodeling of the left ventricular myocardium. It can be assumed that the assessment of salt sensitivity makes it possible to verify patients with the most unfavorable changes in parameters of ambulatory blood pressure monitoring and significant remodeling of the left ventricular myocardium. This approach can be used to individualize pharmacotherapy in patients with arterial hypertension and increase its effectiveness.

Isolated central aortic hypertension and pregnancy complications

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): State Task Background. Physiological changes occurring in the body of pregnant woman (PW) contribute to the adaptation of the cardiovascular (CV) system to the increasing metabolic needs of the mother"s body. Such changes, however, differ in normal and pathological pregnancy (B) and, as a rule, precede the clinical manifestations of a number of its complications. The role of isolated shifts in central aortic pressure (CAP) in the development of the problematic course of pregnancy and childbirth has not yet been studied. Diagnosis of such shifts requires special technology. The aim is to estimate the possible associations of CAD indicators with the development of vascular complications of pregnancy. Materials and methods. We measured the CAP in the office format in 184 pregnant women (mean age 26 ± 2.7 years) in the 1st trimester B. Exclusion criteria: the presence of an increase in peripheral blood pressure at the time of examination and in the anamnesis. Noninvasive assessment of the CAP parameters was performed using the oscillometric method on the BPLab Vasotens device (Petr Telegin, Russia). The device met international accuracy standards for oscillometric blood pressure recorders and is recommended for use in pregnant women. The development of such complications as gestational hypertension/preeclampsia (GAG/PE), gestational diabetes mellitus (GSD), fetal growth retardation syndrome (SDRP) and preterm birth (PR) was evaluated. For the analysis of possible associations of CAD indicators with the development of vascular complications of pregnancy we carried out it from the standpoint of interval analysis in the framework of systolic CAD-tertile groups formed by systolic pressure in the aorta Statistical processing was performed using the application software package "Statistica 10.0" (StatSoft Inc, USA). Results: It turned out that incidence of each of studied complications was higher among PW from third CAP-tertile group. Significant differences relate to GH / PE – 1,6%, 1,6% and 18,0% (p1-3 = 0,0002; р2-3 = 0,0002). The total number of all complications was also found to be the highest in PW who were related with upper CAP-tertile group - 6,4%, 8,2% and 29,4% (p1-3 = 0,0001; р2-3 = 0,0005). Persons with the absence of the discussed complications among these women, respectively, turned out to be minimal. Conclusion. Thus, the undoubted association of increased CAD with the development of various pregnancy complications was demonstrated. It is noteworthy that this association was found in women with normal peripheral blood pressure. This means that they have isolated central hypertension, which requires timely special diagnosis. Therefore, it is advisable to include this technology in the program of management of pregnant women in order to effectively form risk groups for the development of these complications of current pregnancy, which, in turn, are known to predispose to the appearance of SS diseases in the long and not very long term.