The impact of obesity on the parameters of cardiovascular remodeling, cerebral blood flow and autonomic regulation of cardiac rhythm in hypertensive patients

Abstract

Objective. The aim of this study was to assess autonomic regulation disturbances, disorders of systemic, brain and intra-cardiac hemodynamics and to find out the features of vascular and cardiac remodeling in patients with arterial hypertension associated with obesity. Materials and Methods. The study involved 82 patients with stage II hypertension combined with obesity (39 men and 43 women) and 18 (12 men and 6 women) patients with essential hypertension with normal body weight. All the patients underwent general clinical examination, ECG Holter monitoring with heart rate variability analysis, 24h ABPM, duplex echocardiography and pulsed-wave Doppler of extracranial vessels. Results. Patients with essential hypertension associated with obesity have significantly higher average daily SBP by 9.4 % (p = 0.036), average DBP by 12.1 % (p = 0.027) and hypertension time index by 83.3 % (p = 0.012), diastolic size of LA by 11.1 % (p = 0.007), IVSTd by 23.7 % (p = 0.001), LVMI by 14.3 % (p = 0.022) and reduced volume-mass index of LV by 18.8 % (p = 0.013). In patients with essential hypertension with obesity we observed a significant decrease in Vmax in the left CCA by 16.5 % (p = 0.003) and in the right CCA by 12.6 % (p = 0.046), Vmean in the left CCA by 16.8 % (p = 0.001) and in the right CCA by 14.4 % (p = 0.009), reduced Vmax by 19.1 % (p = 0.002) and Vmean by 21.9% (p = 0.002) in the right ICA. Levels of Vmax and Vmean in the left MCA in hypertensive patients with obesity were lower by 10.2% (p = 0.043) and 12.5 % (p = 0.044), while the index of vascular reactivity sensitive to hypercapnia in the left MCA was lower by 14.6 % (p = 0.015). In overweighed patients with hypertension the linear Vmax in the left VA was lower by 13.9 % (p = 0.015) and Vmean 14.5 % (p = 0.013), in the right VA Vmax and Vmean were lower by 17.7 % (p = 0.011) and 25.8 % (p = 0.003). In group with hypertension and obesity Vmean in BA showed a reduction by 17.3 % (p = 0.021), and index of reactivity sensitive to hypercapnia by 23.1 % (p = 0.002). Hypertensive patients with obesity and with normal body weight did not differ by temporal and spectral parameters of HRV. Index LF/HF in both groups exceeded 2 cu. Conclusions. The presence of obesity in patients with essential hypertension is accompanied by significantly higher average SBP and DBP, daily hypertension time index according to 24h ABPM, a significant increase in diastolic LA size, IVSTd, LVMI and decrease of LV volume-mass index, decreased blood flow in CCA, right ICA, left MCA, both VA and BA, index of vascular reactivity sensitive to hypercapnia in the left MCA and BA. In patients with essential hypertension regardless of whether obese or of normal body weight sympathetic part of the autonomic nervous system prevails.