The Relationship between the Parameters of Blood Pressure Variability and Arterial Wall Stiffness in Patients with Arterial Hypertension

ORIGINAL ARTICLE
Nigora B. Tursunova, Ulugbek I. Nizamov, Ravshanbek D. Kurbanov, Gulnoz A. Khamidullaeva, Guzal J. Abdullaeva, Alexander B. Shek

 
International Journal of Biomedicine. 2019;9(3):197-201.
DOI: 10.21103/Article9(3)_OA1
Originally published September 15, 2019

Abstract: 

The purpose of the research was to study the significance of blood pressure variability (BPV) in the assessment of arterial stiffness (AS) in patients with arterial hypertension (AH), and their possible relationship with the indicators of structural and functional remodeling of the myocardium, serum lipid spectrum, and homeostasis system.
Materials and Methods: A total of 138 patients (mean age of 56.7±12.8) with AH were examined. All patients were twice divided consecutively into two groups: one on the basis of age (the age groups ≥60 years and <60 years), and another on the basis of the presence or absence of isolated systolic hypertension (ISH). The age groups ≥60 years and <60 years did not differ in terms of BP: average 24-h SBP was 129.3±14.7 mmHg and 136.5±18.9 mmHg, respectively, and average 24-h DBP was 81.9±11.5 mmHg and 81.0±10.3 mmHg, respectively, P<0.05 in both cases. The ISH and systolic-diastolic hypertension (SDH) subgroups did not significantly differ in sex composition and average 24-h SBP (131.2±8.6 mm Hg and 137.5±17.0 mmHg, respectively; P>0.05). In the ISH subgroup, average 24-h DBP was significantly lower than in the SDH subgroup: 74.5±4.8 mmHg and 87.4±10.9 mmHg, respectively (P=0.000). All patients underwent the following examinations: assessment of traditional risk factors, physical examination, clinical and biochemical laboratory methods, 12-lead ECG, echocardiography, 24-hour ABPM, assesment of the AS parameters, and measuring the carotid-femoral pulse wave velocity (PWVcf).
Results: The age group ≥60 years is characterized by a significant increase in AS compared to the age group <60 years. In the age group ≥60 years, the levels of daytime and nighttime pulse pressure (PP) and the variability of daytime SBP and PP were significantly higher than in the age group <60 years. The increase in AS is associated with an increase in the daytime and nighttime SBP and PP, with the variability of daytime SBP and PP. The relationship between AS and the variability of SBP and PP, as well as the morning SBP RoR, was revealed. An increase in AS is also associated with an increase in the degree of the left ventricular myocardium remodeling. In ISH patients, compared to SDH patients, a significant increase in AS was found. ISH patients were characterized by a greater variability in the daily SBP and PP. In the SDH subgroup of patients, an increase in fibrinogen level was revealed. The level of cardiovascular risk (CVR) in AH is associated with an increase in the daily variability of SBP, DBP and PP.
Conclusion: In a comprehensive examination of patients with AH, it is advisable to perform ABPM with simultaneous determination of AS parameters. The increased AS and BPV mark the patients belonging to a higher CVR group.

Keywords: 
arterial hypertension • isolated systolic hypertension • ambulatory blood pressure monitoring • arterial stiffness • pulse wave velocity
References: 
  1. Banegas JR, Lopez-Garcia E, Dallongeville J, Guallar E, Halcox JP, Borghi C, et al. Achievement of treatment goals for primary prevention of cardiovascular disease in clinical practice across Europe: the EURIKA study. Eur Heart J. 2011;32(17):2143-52. doi: 10.1093/eurheartj/ehr080.
  2.  Chow CK, Teo KK, Rangarajan S, Islam S, Gupta R, Avezum A, et al.; PURE Study Investigators. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA.2013; 310(9):959-68. doi: 10.1001/jama.2013.184182.
  3. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al.; ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-3104. doi: 10.1093/eurheartj/ehy339.
  4. Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D, et al.; European Network for Non-invasive Investigation of Large Arteries. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 2006;27(21):2588–605.
  5. Mihalcea DJ, Florescu M, Suran BM, Enescu OA, Mincu RI, Magda S, Patrascu N, Vinereanu D. Comparison of pulse wave velocity assessed by three different techniques: Arteriograph, Complior, and Echo-tracking. Heart Vessels. 2016;31:568–77. doi: 10.1007/s00380-015-0632-x. 
  6. Van Bortel LM, Laurent S, Boutouyrie P, Chowienczyk P, Cruickshank JK, De Backer T, et al.; Artery Society; European Society of Hypertension Working Group on Vascular Structure and Function; European Network for Noninvasive Investigation of Large Arteries. Expert consensus document on the measurement of aortic stiffness in daily practice using carotid-femoral pulse wave velocity. J Hypertens. 2012;30(3):445-8. doi: 10.1097/HJH.0b013e32834fa8b0.
  7. Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L, et al. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension. 2001;37(5):1236-41.
  8. Tsivgoulis G, Bogiatzi C, Heliopoulos I, Vadikolias K, Boutati E, Tsakaldimi S, et al. Low ankle-brachial index predicts early risk of recurrent stroke in patients with acute cerebral ischemia. Atherosclerosis. 2012;220(2):407-12. doi: 10.1016/j.atherosclerosis.2011.11.009.
  9. Suzuki J, Sakakibara R, Tomaru T, Tateno F, Kishi M, Ogawa E, et al. Stroke and cardio-ankle vascular stiffness index. J Stroke Cerebrovasc Dis. 2013 Feb;22(2):171-5. doi: 10.1016/j.jstrokecerebrovasdis.2011.07.010.
  10. Ben-Shlomo Y, Spears M, Boustred C, May M, Anderson SG, Benjamin EJ, et al. Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects. J Am Coll Cardiol. 2014;63(7):636-646. doi: 10.1016/j.jacc.2013.09.063.
  11. Gosse P, Cipriano C, Bemurat L, Mas D, Lemétayer P, N'Tela G, Clementy J. Prognostic significance of blood pressure measured on rising. J Hum Hypertens. 2001;15(6):413-7.
  12. Blacher J, Guerin AP, Pannier B, Marchais SJ, Safar ME, London GM. Impact of aortic stiffness on survival in end-stage renal disease. Circulation. 1999;99(18):2434-9.
  13. Boutouyrie P. New techniques for assessing arterial stiffness.Diabetes Metab. 2008;34 Suppl 1:S21-6. doi: 10.1016/S1262-3636(08)70099-5.
  14. Nazarova OA, Maslennikova OM, Fomin FYu. Evaluation of the elastic properties of blood vessels in the clinic of internal diseases. Ivanovo; 2007. [In Russian].
  15. Voigt JU, Pedrizzetti G, Lysyansky P, Marwick TH, Houle H, Baumann R, et al. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2015;16(1):1-11. doi: 10.1093/ehjci/jeu184.
  16. Devereux RB, de Simone G, Ganau A, Roman MJ. Left ventricular hypertrophy and geometric remodeling in hypertension: stimuli, functional consequences and prognostic implications. J Hypertens Suppl. 1994;12(10):S117-27.
  17. McVeigh GE, Hamilton PK, Morgan DR. Evaluation of mechanical arterial properties: clinical, experimental and therapeutic aspects. Clin Sci (Lond). 2002;102(1):51-67.
  18. Laurent S, Boutouyrie P. Recent advances in arterial stiffness and wave reflection in human hypertension.Hypertension. 2007;49(6):1202-6.
  19. Nikitin YuP. New fundamental and applied bases of atherogenesis. Bulletin of SB of RAMS. 2006;(2):6–14. [Article in Russian].
  20. Troitskaya EA, Kotovskaya YuV, Kobalava ZhD. High inter-visiting blood pressure variability - a possible marker of the severity of cardiovascular disease in patients with arterial hypertension (Abstract of the IV Eurasian Congress of Cardiologists). Eurasian Heart Journal. 2016;(3):47-48. [in Russian]..

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Received June 18, 2019.
Accepted August 19, 2019.
©2019 International Medical Research and Development Corporation.