ARTERIAL HYPERTENSION IN POSTMENOPAUSAL WOMEN WITH ABDOMINAL OBESITY: ROLE OF INFLAMMATORY RESPONSE MARKERS, LEPTIN AND SEX HORMONES IN PATHOGENESIS OF VASCULAR WALL STIFFNESS

Abstract

Objective: Arterial hypertension (AH) with abdominal obesity, especially during postmenopause, remains one of the most serious medical and social problems. The objective was to study features of AH in postmenopausal women with abdominal obesity and to assess the role of markers of inflammatory response, leptin and female sex hormones in the pathogenesis of vascular wall stiffness. Design and method: The study included 164 patients randomized into 3 groups. Group 1 (control) consisted of 42 healthy women aged 44.43 ± 14.26 years, group 2 - 62 women aged 60.69 ± 7.09 years with AH and group 3 included 60 women aged 57.24 ± 7.4 years with AH and abdominal obesity. Parameters of 24-hour ambulatory blood pressure monitoring; sphygmography - pulse-wave velocity (PWV); lipid profile parameters, inflammatory markers (high-sensitivity C-reactive protein, TNF-alpha, homocysteine, interleukin-1 beta, -6, -8); endothelial dysfunction markers (endothelin-1, nitrites) and hormonal profile (sex hormone levels, cortisol and testosterone), leptin were measured. Results: Analysis results revealed that systolic and diastolic blood pressure indices were significantly higher in group 3 in comparison with group 2. An excess of the variability of systolic blood pressure at night was recorded in group 2 and 3 (p < 0.017). Higher PWV values were registered in group 2. Lower levels of sex hormones and significant increase in the level of inflammatory markers were found in groups 2 and 3 compared to the control group. We revealed multiple multidirectional correlations between the studied parameters. Logistic regression method detected the main biochemical markers that affect increase in stiffness of the vascular wall, such as leptin (odds ratio (OR): 1.021, 95% confidence interval (CI): 1.004–1.039, p = 0.018), high-sensitivity C-reactive protein (OR: 1.300; 95% CI 1.091–1.549, p = 0.003) and endothelin-1 (OR: 1.0242; 95% CI 1.042–1.794, p = 0.024). Rise of each marker by unit of measurement leads to increase in PWV by 2.1%; 1.3 times by 2.4%, respectively. Conclusions: Features of AH in postmenopausal women with abdominal obesity are systolic-diastolic AH with increase in variability of systolic blood pressure at night. The main markers determining the state of elastic properties of the vascular wall are leptin, high-sensitivity C-reactive protein and endothelin-1.