THE RELATIONSHIP BETWEEN BLOOD PRESSURE VARIABILITY AND CARDIOVASCULAR REMODELING IN HYPERTENSION DEVELOPED IN THE ELDERLY

Abstract

Background. The prevalence of arterial hypertension (HTN) increases with age, but the causes of HTN in elderly and young age are different. The contribution of the specific parameters of high blood pressure (BP) in the pathogenesis of organ damage in the elderly has not been studied enough. Objective. We assessed the effect of BP variability (BPV) on left ventricular (LV) remodeling and vascular stiffness in patients with HTN developed at age before and over 65 years. design and methods. Altogether 122 elderly patients were enrolled and divided into 3 groups: group 1–45 patients with newly diagnosed HTN 1–2 degree at the age over 65 years (21 males, 24 females, the average age — 71,7 ± 2,6 years), group 2–39 subjects with newly diagnosed HTN 1–2 degree under 65 years old (18 males, 21 females, the average age — 68,4 ± 2,4 years). The 3rd control group, comprised 38 elderly subjects without HTN (20 males, 18 females, the average age — 67,5 ± 2,0 years). At baseline, none of the patients achieved target BP. At admission to the hospital, two-component antihypertensive therapy was prescribed to all patients, it included a blocker of the renin-angiotensine-aldosterone system (RAAS) — an angiotensin-converting enzyme inhibitor or angiotensin receptor antagonist) and calcium channel blocker (amlodipine in all cases). Short-term BPV was assessed by ambulatory BP monitoring (ABPM), medium-term BPV — based on the BP monitoring for 7 days, and long-term BPV — based on the 3-month self-monitoring of BP. Central aortic pressure was also measured. LV myocardial mass index and LV relative wall thickness (2T/DD) were assessed by 2D-echocardiography, and early diastolic flow velocities E, A and the ratio E/A were evaluated by spectral Doppler. Pulse wave velocity, cardio-ankle vascular index (R-CAVI and L–CAVI), ankle-brachial index (ABI) and the biological arterial age were assessed by sphygmomanometry. Results. Increased BPV seems to be an indicator in elderly, as elderly patients without HTN show increased SBP and DBP short-term variability. However, the maximum rate of BPV increase was found in patients with the HTN development in the age over 65 years. In the same group, the correlation between BPV and LV and vascular remodeling was the most severe. The increase in visit-to-visit DBP variability had the greatest impact on the arterial wall stiffness, while visit-tovisit SBP variability affected LV remodeling. The increase in the mediumand long-term BPV was found to be a more powerful predictor of cardiovascular remodeling compared to the increase in short-term BPV assessed by ABPM. Thus, arterial stiffness may be an important factor leading to the increase in both short-term and longterm BPV. Conclusions. BPV measurement should be widely implemented for the assessment of cardiovascular risk and the overall effectiveness of antihypertensive therapy.