Features of a circadian rhythm of arterial pressure in patients with resistant arterial hypertension and pseudo-resistant arterial hypertension

Abstract

Aim: To determine the peculiarities of circadian rhythm of arterial pressure in patients with true resistant arterial hypertension (RAH) and pseudo-resistant arterial hypertension (PRAH). Material and methods. 52 patients with suspected resistant arterial hypertension (RAH) were examined according to the criteria of the European Society of Hypertension (ESH, 2013). Antihypertensive therapy (ACE inhibitors/sartans, calcium antagonist, and a diuretic) was administered to 44 patients with suspected RAH in the maximum therapeutic doses. In 20 patients, with the combined therapy, the normalization of blood pressure was not achieved. The presence of RAH confirmed it. These patients formed group I. However, blood pressure in 24 examined patients was normalized, indicating a pseudo-reflective course of hypertension. These patients formed a control group (group II). The measurements of the office and ambulatory blood pressure were performed in all patients for assessing the characteristics of a circadian rhythm of blood pressure. Results. According to ambulatory blood pressure monitoring (ABPM), in patients with RAH, a significantly higher level of systolic blood pressure (SBP) was recorded daily, during daytime and nighttime, as well as mean night value of diastolic blood pressure (DBP). The daily indices of SBP and DNP were significantly lower in the group of patients with RBP. Insufficient reduction of blood pressure (type non-dipper) was observed in 8 (35%) patients in nighttime; Nigh-piker — in 5 patients (25%). The rest of the patients had a normal circadian rhythm profile of BP. In group II, 11 (45.8%) patients had normal daily blood transfusion profile, 8 (33.4%) patients had non-dipper disorders, only 2 patients had nigh-piker type (8, 3%), and in three patients (12.5%) — recorded excessive decrease in blood pressure at night — over-dipper type. The disturbance of the variability of blood pressure were found more frequently in group І (72.7%) than in the ІІ group — 43.0% (р<0.04). The morning gains of SBP and DBP were also significantly higher in patients of the group I (p = 0,026 and p = 0,001, respectively). Conclusion. Patients with RBP are characterized by higher SBP data according to BPMM during the daytime and nighttime. They have more frequent disturbances of the circadian rhythm due to type of non-dipper, night-piker and significantly higher values of morning BP increase compared with the pseudo-resistant arterial hypertension.