Features of vascular rigidity in patients with arterial hypertension in combination with chronic heart failure and senile asthenia syndrome

Abstract

Objective. The aim of the study was to evaluate the features of vascular rigidity in patients with arterial hypertension (AH) depending on the presence of chronic heart failure (CHF) and senile asthenia syndrome (SAS).Design and methods. 320 patients with AH were divided into two main groups: group 1 — patients with AH and CHF (n = 161), group 2 — patients with AH without CHF (n = 159). Depending on the presence of SAS, patients of each group were divided as follows: subgroup 1A — patients with AH, CHF and SAS (n = 84), subgroup 1B — patients with AH, CHF without SAS (n = 77), subgroup 2A — patients with AH, SAS without CHF (n = 84), subgroup 2B — patients with AH without CHF and without SAS (n = 75). To identify SAS, we used the “Age is not a barrier” questionnaire and a short battery of physical functioning tests. The parameters of vascular stiffness were determined using a device for daily monitoring of blood pressure BPLab using Vasotens technology (Peter Telegin, Nizhny Novgorod). The obtained data were processed using STATISTICA 12.0 (StatSoft Inc., USA), SPSS 21.0, MedCalc (version 9.3.5.0).Results. Analysis of the effect of SAS on vascular stiffness showed that in patients with AH, CHF and SAS, compared with patients with AH, CHF without SAS, there were statistically significantly lower values of the reflected wave propagation time (RWTT) (p = 0,001) against the background of higher values pulse wave velocity in the aorta (РWVао) (p < 0,001), arterial stiffness index (ASI) (p = 0,0001) and ambulatory arterial stiffness index (AASI) (p = 0,002), which indicates more pronounced vascular stiffness in patients with AH, CHF in the presence of SAS. In the group of patients with AH and SAS without CHF, compared with patients with AH without CHF and without SAS, higher values of РWVао (p < 0,001) and “adjusted” index of augmentation index (AIх@75) (p < 0,001) were revealed, which allows to judge the effect of SAS on the development of arterial stiffness in patients with AH without CHF. Analysis of the effect of CHF on vascular stiffness showed that in patients with AH, SAS and CHF, compared with patients with AH, SAS without CHF, statistically significantly lower values of RWTT (p < 0,001) and higher values of РWVао (p = 0,024) were noted, ASI (p < 0,001), AASI (p < 0,001), maximum rate of blood pressure rise (dP/dtmax) (p < 0,001) and AIх@75 (p < 0,001). In the group of patients with AH, CHF without SAS, compared with patients with AH without CHF and without SAS, lower values of RWTT (p < 0,001) and higher values of РWVаo (p = 0,004), ASI (p < 0,001), AASI (p < 0,001) and dP/dtmax (p < 0,001), which in turn demonstrates the contribution of CHF to the development of vascular stiffness in AH patients without SAS. CS.Conclusions. In hypertensive patients over 80 years of age, the development of both SAS and CHF was accompanied by limited compliance of the aortic walls and increased vascular stiffness in the peripheral arteries. Significantly more pronounced changes in vascular stiffness parameters were noted in patients with a combination of AH, CHF and SAS compared with those in patients with AH and CHF or AH and SAS, which indicates an increase in vascular stiffness, and, consequently, a higher risk of cardiovascular diseases in this combined pathology.