Evaluation of cardiac and vascular remodeling in patients with arterial hypertension in combination with atherosclerosis of the lower extremity arteries

Abstract

Objective: to evaluate the features of cardiac and vascular remodeling in patients with arterial hypertension (AH) and atherosclerosis of the arteries of the lower extremities (LAA) of varying severity. Materials and methods: the study involved 120 patients with hypertension. Depending on the presence of AANC, all patients were divided into 3 groups: group 1 — 46 patients with hypertension and clinically manifested AANC, group 2 — 39 patients with hypertension and asymptomatic AANC, group 3 — 35 patients with hypertension without AANC. The characteristics of cardiac and vascular remodeling were assessed based on the results of 24-hour blood pressure monitoring (ABPM) using Vasotens technology, triplex ultrasound scanning (UTS) of the arteries of the lower extremities (LEA), and echocardiographic examination (EchoCG). Statistical data processing was carried out using Microsoft Office Excel 16 (2015, Microsoft, USA), Statistica 10.0 (StatSoft, USA) and IBM SPSS Statistica 26.0 (IBM, USA). Results: in the group of patients with severe circulatory disorders of the lower extremities, compared with patients with asymptomatic AANK, significantly lower values of the indicator — reflected wave propagation time (RWTT, ms) (p = 0.006) and significantly higher values of the indicator — augmentation index (AIX) were revealed) and augmentation index in the aorta (AIXao) (p<0.05). A direct statistically significant correlation of moderate strength was revealed between the degree of stenosis (%) of the ANC and the values of the AIX and AIXao indicators (r = 0.345, p = 0.001). Higher values of the dimensions of the walls of the left ventricle (LV) were determined: the thickness of the interventricular septum (IVS) and the posterior wall of the left ventricle (PLW) in patients of the 1st and 2nd groups in comparison with the indicators in patients of the 3rd group (p<0 .05). Patients of all three groups had thickening of the left ventricle and intraventricular septum (>11 mm) and an increase in LVMI. In patients with hypertension and severe AANC, the maximum values of LVMI were determined, which were significantly higher than the corresponding values in patients of the 2nd (p = 0.004) and 3rd (p = 0.0001) groups. LV systolic function in all patients included in the study was assessed as intact. However, the highest ejection fraction (EF) values were recorded in patients with hypertension without AANC, and were significantly higher than those in patients with hypertension and concomitant asymptomatic AANC (p = 0.02), as well as in patients with hypertension and clinically manifested AANC (p =0.001). Conclusions: the progression of AANK was associated with an increase in the stiffness of both peripheral and main arteries, which was accompanied by an increase in the load on the myocardium, which in 97.8% of cases led to more pronounced myocardial remodeling of the concentric hypertrophy type.