BLOOD PRESSURE VARIABILITY AND MYOCARDIAL STIFFNESS IN THE MIDDLE-AGED NAÏVE HYPERTENSIVE PATIENTS

Abstract

Objective: to assess left ventricular (LV) and left atrial (LA) echocardiographic myocardial stiffness parameters in the middle-aged patients with stage II grade 1–2 essential arterial hypertension (EAH) without concomitant cardiovascular diseases in relation to short-term blood pressure variability (BPV). Design and method: Retrospective, controlled study. According to medical records data a group of naïve patients 40–65 years old with stage II grade 1–2 EAH (n = 100, 47.0% men, mean age 51.9 ± 6.5 years) and a group of healthy controls (n = 86, 32.6% men, mean age 48.8 ± 5.8 years) was retrospectively formed. In all included participants clinical, echocardiographic data (acquired using Vivid 7 Dimension system, GE) and ambulatory blood pressure monitoring [ABPM] (BPLab, BP2005–01.04.00.2540, Petr Telegin, Russia) parameters were available. LV end-diastolic stiffness, LV end-systolic elastance, LV diastolic elastance, LA stiffness index (LASI), LA expansion index and tissue Doppler-derived LA strain were calculated as myocardial stiffness parameters. 2-D speckle tracking echocardiography data were used for determination of LV myocardial global longitudinal peak strain (LV GLPS). BPV was estimated as standard deviation based on ABPM reports. Hypertensive patients were divided into 2 subgroups according to median value of day-time systolic BPV (dtSBPV) – 15 mmHg and into 2 subgroups according to median value of night-time systolic BPV (ntSBPV) – 14 mmHg (subgroups of «high» and «normal» dtSBPV and ntSBPV), and study parameters analyzed separately in these subgroups compared to the control group. Results: in hypertensive patients with «high» dtSBPV (n = 59) LV GLPS (−17.5 ± 3.0%) was significantly (p = 0.002) lower in absolute value and LASI (0.17 ± 0.09) was significantly (p = 0.015) higher compared to the controls (respectively, −19.5 ± 2.6% and 0.12 ± 0.06). No significant differences in myocardial stiffness parameters were obtained compared to the controls in hypertensive patients with «normal» dtSBPV and both «normal» and «high» ntSBPV. Conclusions: the present study reveals that higher dtSPBV predispose to increased LV myocardial stiffness in untreated middle-aged patients with stage II grade 1–2 EAH without concomitant cardiovascular diseases in comparison with sex- and age-matched healthy individuals with normal blood pressure.