Показатели суточного мониторинга артериального давления у лиц старческого возраста c хронической сердечной недостаточностью в зависимости от жесткости сосудов

Abstract

INTRODUCTION: Measurement of arterial pressure (AP) is a standard method for assessing the risk of developing cardiovascular diseases. Analysis of systolic and diastolic pressure, as well as their ratio, can help determine the risk of developing cardiovascular diseases. One of the ways to diagnose elevatedarterial pressure is daily monitoring of arterial pressure (DMAP). An increase in AP in the elderly is usually associated with an increase in the stiffness of the vascular walls. This leads to an increase in systolic arterial pressure (SAP) and pulse pressure (PP), as well as a decrease in diastolic arterial pressure (DAP). Elevated arterial pressure enhances the load on the heart and can lead to its pathological alterations. A decrease in DAP impairs the blood supply to the heart, which can cause ischemia and fibrosis; the result isdevelopment of diastolic dysfunction, which is the main cause of chronic heart failure (CHF). Currently, a promising way to determine the arterial stiffness is measurement of a cardio-ankle vascular index.The prognostic and diagnostic value of this parameter has been confirmed by numerous studies. It is important to study the parameters of the daily AP profile and arterial stiffness in older patients with CHF. This permits to identify malignant forms of elevated blood pressure, which can lead to cardiovascular complications. AIM: To study the characteristics of the parameters of the daily arterial pressure profile in elderly patients with CHF, depending on the vascular stiffness determined by volume sphygmography. MATERIALS AND METHODS: One hundred and twenty elderly patients with CHF undergoing treatment in a cardiology hospital were examined. By the method of volume sphygmography, the patients were divided into groups with ‘vessels of normal stiffness’ (group 1) and ‘stiff vessels’ (group 2), with subsequentDMAP. A statistical analysis of the parameters of the daily AP profile in the groups was performed. RESULTS: In patients of group 1, both daytime and nighttime SAP, DAP and PP, were significantly higher than in patients of group 2. Besides, in group 1, there was a nighttime decrease in SAP and DAP, while the morning rise of SAP was statistically higher in group 2, and no differences were recorded between the groups in the morning rise of DAP. When assessing the ankle-brachial index in patients of group 2, daytime and nighttime SAP and DAP were statistically higher. In group 1 (with probable peripheral atherosclerosis), PP was higher both during the day and at night. The nocturnal decrease in SAP was statistically higher in group 2, while the nocturnal decrease in DAP prevailed in group 1. The morning rise of SAP and DAP was higher in group 1. CONCLUSION: The DMAP data may indicate to some extent the severity of hypertension in patients with CHF, and this probably depends on the ‘stiffness of the vessels’. In elderly patients with CHF with ‘normal stiffness’ of vessels, the parameters of the daily arterial pressure profile were higher than in patients with ‘stiff vessels’. However, the daily range of parameters of the daily arterial pressure profile was greater in the group of patients with ‘stiff vessels’ (group 2).