CENTRAL BLOOD PRESSURE AND ARTERIAL STIFFNESS IN HYPERTENSIVE PATIENTS WITH AORTIC ANEURYSM. AN ACTIVE TILT-TEST STUDY

Abstract

Objective: To assess the pulse wave velocity (PWV) and the orthostatic changes of peripheral (brachial) and central blood pressure (P/CBP) in patients with ascending aortic aneurysm (AAA) and thoracoabdominal AA (TAAA). Design and method: A total of 79 patients with AAA (n =41, 28 males; 54±13 y.o.) and TAAA (n =38; 33 males; 68±8 y.o.) were examined prior to surgical treatment. Brachial BP, CBP and PWV were measured in the supine position after 10 min of rest and then after 5 min of active standing using OMRON M3 EXPERT (Japan) and SphygmoCor (Australia). Ambulatory BP monitoring (ABPM) and calculation of 24-h CBP were performed with BPLab (Russia). Results: At baseline, 10 patients with AAA and 17 patients with TAAA exceeded the target BBP. The TAAA group exhibited a higher PWV compared to AAA (10.8±1.9 vs. 8.4±2.5 m/s, p <0.001). Systolic CBP decreased during active standing in 14 AAA and in 19 TAAA patients (p =0.001). The 24-hour systolic CBP was similar in both groups, the 24-hour diastolic CBP was higher in TAAA (76±9 and 63±11 mm Hg, p =0.004). Patients experiencing a BP drop (>10 mm Hg) while standing had higher values of systolic and diastolic CBP than those without orthostatic hypotension (systolic CBP 133±18 vs 123±17 mm Hg, p =0.01; diastolic CBP 82±13 vs 75±13 mm Hg, p =0.04). The PWV exhibited a strong correlation with age (r=0.594, p=0.0001), systolic CBP (r=0.308, p=0.008), diastolic CBP (r=0.340, p=0.004), orthostatic systolic CBP (r=0.262, p=0.031), and orthostatic diastolic CBP (r=0.253, p=0.037). A higher percentage of patients diagnosed with AAA were prescribed beta-blockers, loop diuretics, and aldosterone antagonists. Conclusions: Patients with TAAA had higher arterial stiffness compared to those with AAA. The reduction of both systolic and diastolic blood pressure during active orthostasis was more frequent in TAAA patients. This was despite the fact that AAA patients were treated more intensively.