Daily profile of arterial and central aortic pressure in patients with arterial hypertension and non-alcoholic fatty liver disease

Abstract

Оbjective : to evaluate the features of daily monitoring of arterial and central aortic pressure in patients with arterial hypertension and non-alcoholic fatty liver disease. Materials and methods: a comparative cross-sectional study was conducted, which involved 120 patients (continuous sample, unorganized population), aged 45 to 65 years (mean age 56.2±8.8 years), including men (34 (28.3%) with AH stage I–II, 1–2 degree. The main group included 60 patients with hypertension and NAFLD, the control group included 60 patients with isolated hypertension. When examining patients, a clinical examination was carried out: taking an anamnesis, measuring "office" blood pressure, anthropometric parameters, calculating body mass index (BMI), WC. 24-hour monitoring of arterial (ABPM) and central aortic pressure (CAP) was assessed using the BPLab complex and Vasotens 24 software (LLC Petr Telegin, Russia). The SCORE scale was used to calculate total cardiovascular risk and 10-year fatal risk. Results : all patients of the study groups underwent ABPM. It was proved that in the patients of the main group, the IV SBP and IV DBP during the day and night significantly exceeded the similar parameters of patients in the comparison group (IV SBP: p=0.0019, p=0.007; IV DBP: p=0.009, p=0.009, respectively). One of the important criteria for assessing blood pressure was the determination of the degree of nighttime decrease in SBP and DBP — the daily index (SI), characterizing the balance in the work of the sympathetic and parasympathetic parts of the autonomic nervous system. In the main group, compared with the control group, there were more patients with SI DBP in the range from 0.0% to 10.0% (non-dipper) (p=0.034), with an increase in SBP at night (night-picker) (p=0.031). When assessing the parameters of CAP, in patients with AH and NAFLD, statistically significantly higher values of mean daily systolic (SADAo) and diastolic (DADo) aortic pressure were observed (p=0.016, p=0.039, respectively), SBP in the daytime (p=0.027), SADao and DADAO at night (p=0.002, p=0.003, respectively), compared with patients with isolated hypertension. Calculation of the risk of cardiovascular complications, in patients with hypertension and NAFLD, a significant increase in the 10-year risk of cardiovascular events was determined, compared with patients with isolated hypertension (3.7 (1.6; 6.0) vs 2.0 (0.6 ;4.3) %, p=0.013). Conclusion : according to the results of 24-hour BP monitoring, in patients with AH and NAFLD, compared with patients with isolated AH, a more significant increase in mean SBP and DBP, an increase in the rate of morning rise and BP variability, and the hypertension time index were revealed. In the main group, patients with a nocturnal increase in SBP were detected significantly more often, which indicates a greater risk of cardiovascular complications in patients with hypertension and NAFLD. In addition, compared with patients with isolated AH, patients with AH and NAFLD showed more significant increases in average daily and nighttime SBPao and DADAO.