Features of vascular motor endothelial function in hypertensive patients with chronic heart failure

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. The main part of the pathogenesis of arterial hypertension (AH) is a remodeling of the vascular system and the state of the vascular endothelium, which functions as a trigger mechanism for the implementation vasoregulating mechanisms. Vascular endothelium is involved in the provision of local processes of hemostasis, proliferation, migration of blood cells in the vessel wall, which is also associated with the regulation of vascular tone and the development of atherosclerosis. Purpose To study the vascular motor endothelial function in hypertensive patients with chronic heart failure (CHF). Methods Vascular mechanisms of pathogenesis have been studied in 172 patients aged (54,2±6,2) years, men 84 and women 88, with uncomplicated hypertension II-III degree. Echographic system Acuson Sequoia 512 was used for ultrasound imaging of the heart. The diameter of the brachial artery (D, mm), flow velocity (V, m/s), the ratio D/V, Δd (%) - an increase in the diameter of the artery decompression, ΔdN (%) - an increase in the diameter of the artery sample with nitroglycerin and the ratio Δd/ΔdN were measured. Results Due to the reduction in brachial artery diameter (with AH stage II 55, l% and AH stage III 48.7%, p <0.01) decreased blood flow velocity in the whole group is 36.4%, which is as much depended on the degree of hypertension (p <0.01). Conducting tests for decompression and nitroglycerin showed that reduced growth in brachial artery diameter in the total group on the decompression was compared with the normal 51.1%: in AH II degree - by 48.8% and III level by 52.2% (p<0.01). The test with nitroglycerin: the larger group of hypertensive patients reduced vasodilation was 21.1%, II degree - 13.8%, and III degree - 30.7% (p<0.01). Conducting tests for decompression showed that normal type vasodilatory response occurred only in 27.4% of patients, with II degree in 33.8% and AH III in 22% of patients. Reduced response to decompression was 60% of patients with AH II - in 43.2%, and III degree - at 56.8% and constrictor - in 12.6% of them in AH II degree at - 6.2% and 17 % at AH III. The test with nitroglycerin: normal vascular reaction occurred in 33.5% of patients, decreased in 59.9% and constrictor in 9.6% of patients. Reduced vasoconstrictor response to nitroglycerin was more common in patients with AH II degree. Cunclusion These results define the nature of the preferred choice of antihypertensive drugs such as normalizing pressure and have a positive effect on the endothelium, which is also associated with a reduction of myocardial hypertrophy and vascular wall.