ORTHOSTATIC RESPONSE OF PERIPHERAL AND CENTRAL BLOOD PRESSURE IN PATIENTS WITH HYPERTENSION AND ATHEROSCLEROTIC CAROTID STENOSIS

Abstract

Objective: To determine the frequency and severity of orthostatic responses of central and peripheral blood pressure (BP) during the Active Stand Test (AST) in patients with arterial hypertension (HTN) and hemodynamically significant stenosis of the internal carotid artery (ICA). Design and method: The intervention group included patients aged 18 years and older with HTN and ICA stenosis >50% (NASCET) of atherosclerotic origin. Patients with HTN without ICA lesions were considered as controls. In all patients AST was performed with the measurement of peripheral BP in the sitting and standing positions after 3 minutes. Orthostatic hypotension (OH) was diagnosed as per current Guidelines: fall of systolic (S)BP equal or more than 20 mmHg or diastolic BP equal or more than 10 mmHg during AST. In the intervention group, central BP assessment during AST and pulse wave contour analysis were also performed. Results: There were 77 patients in the intervention group (69±8 years, 44 men) and 77 patients in the control group (68±6 years, 43 men). According to the dynamics of peripheral BP, OH was diagnosed in 21 patients (27%) in the intervention group and in 17 patients (22%) in the control group (p=0,46), but systolic OH was more frequently observed in the former (21 vs. 9 patients; p=0.015). The reduction in central systolic (S)BP was more pronounced than delta peripheral SBP (p =0.001). Changes in peripheral SBP during AST were associated with the presence of a significant ICA lesion (beta in ICA =0.201, p=0.03) and baseline SBP (beta= -0.348, p=0.001). The same variables (the fact of ICA lesion and baseline SBP) mostly explained the development of systolic OH (OR 2.95 (95% CI [1.1-7.7], p=0.03 and beta= 0.437, p<0.001, respectively). Conclusions: Asymptomatic OH occurred in 27% of patients with HTN and ICA stenosis, more frequently in the form of isolated systolic OH. The amplitude of central SBP reduction significantly exceeded the dynamics of peripheral SBP The presence of carotid stenosis and higher initial values of peripheral SBP associated with the dynamics of SBP in standing and the occurrence of OH.