Daily Blood Pressure Profile Research Articles

Hyperprolactinemia of various genesis in premenopause: effect on cardiovascular risks, a practical aspect

The pathological aspects of hyperprolactinemia have been well studied to date and primarily affect changes in the reproductive system. Regardless of the genesis of hyperprolactinemia, negative changes include, first of all, dysmenorrhea and hyperan drogenism. Changes in the mammary glands include galactorrhea, mastopathy, and the development of breast cancer. The pathological effects of hyperprolactinemia on other organs and systems, including the cardiovascular system, have been studied less. Few existing studies suggest that elevated prolactin levels can potentially affect cardiovas cular risks and provoke myocardial remodeling, arterial hypertension, hyperhomocys teinemia, and disorders of the plasma lipid profile. Menopausal women are particularly vulnerable in this regard, as the cardioprotective role of estrogens is significantly re duced during this period. In this article, we examined the effect of hyperprolactinemia on the formation of cardiovascular disorders in premenopausal women. The purpose of the study was to evaluate the effect of hyperprolactinemia on the genesis of cardiovascular pathology in premenopausal women. Materials and methods: three groups of premenopausal patients were examined. The patients of the first group (n=26) had previously been diagnosed with pituitary adenoma and were treated with cabergoline, maintaining the target prolactin level for at least two years. According to pituitary MRI, prolactinoma and elevated prolactin levels were de tected in the patients of the second group (n=21), but these patients did not take prolac tin-lowering therapy for various reasons. The third group consisted of the patients with idiopathic hyperprolactinemia who did not receive prolactin-lowering therapy (n=19). The patients of all three groups underwent general clinical examination, determination of the daily blood pressure profile, ECG, echocardiography, determination of the level of lipidogram, homocysteine, and other markers of cardiovascular risk. The results of the study showed that regardless of its genesis, pathological hyperprolactinemia influences the development of cardiovascular pathology in premenopausal women.

RELATIONSHIP OF DAILY BLOOD PRESSURE PROFILE AND ARTERIAL STIFFNESS

Objective: To study the blood pressure daily profile in patients with hypertension (HNT) depending on the pulse wave velocity (PWV). Design and method: We studied 88 treated patients with HNT. The ambulatory BP monitoring (ABPM) was recorded with a Medicom-combi device (Russia) using the oscillometric method. PWV was determined using the SphygmoCor (AtCor Medical Pty Ltd, Australia). Statistical analysis was performed using the SPSS 24.0 software package. Results: Patients were divided into 2 groups depending on PWV level: the first group had a PWV < 10 m/s, and the second group had a PWV > 10 m/s. The mean PWV in the groups was 7.79±1.38 vs. 14.13±1.85 m/s, respectively (p<0.007). Office SBP and DBP didn’t differ between groups. Patients of the second group had significantly higher mean daily SBP (113.64±16.64 vs 128.23±16.91 mm Hg, p=0.0001), mean daytime SBP (116.77±8.99 vs 129.36±7.8 mm Hg, p=0.0001), and mean nighttime DBP (66.26±9.7 vs 71.64±7.1 mm Hg, p=0.04). The load index (LI) of daytime and nighttime SBP was higher in patients with PWV > 10 m/s. LI of SBP daytime: 9.72±15.82% vs. 27.74±35.24%, respectively, p = 0.001. LI of SBP nighttime: 18.34±26.44% vs. 44.2±38.81%, respectively, p = 0.001. Variability and nocturnal falls of SBP and DBP also didn’t differ between the groups. The number of dippers by SBP and DBP was higher in patients with normal PWV, but not significantly: 18% and 12% vs. 13% and 9%, SBP: χ2 = 0.04, p = 0.83; DBP: χ2 = 0.19, p = 0.45. The number of non-dippers by SBP and DBP was significantly higher in the first group: 65% and 66% vs. 50% and 50%; SBP: χ2 = 4.6, p = 0.032; and DBP: χ2 = 5.25, p > 0.05. However, the number of night-pickers by SBP and DBP significantly prevailed in the second group: 17% and 19% vs. 36.4% and 32%, respectively; SBP: χ2 = 9.2, p = 0.003, DBP: χ2 = 5.58, p = 0.019. There were no over-dippers in both groups. Conclusions: Hypertensive patients with high PWV values had more pronounced disorders in their daily blood pressure profile.

FEATURES OF THE DAILY BLOOD PRESSURE PROFILE IN PATIENTS WITH ARTERIAL HYPERTENSION AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Objective: To study the features of the daily blood pressure profile (DBPP) in patients with combination of arterial hypertension (AH) and chronic obstructive pulmonary disease (COPD). Design and method: The study included 47 patients (average age 53.1±2.5 years), 31 women, 16 men with hypertension I-II degrees. Patients were divided into 2 groups: with COPD (n=22) and without COPD (n=25). Duration AH in the group of patients with COPD was 6.5±0.54 years, without COPD 5.1±0.66 years. Exclusion criteria's were: symptomatic hypertension, cerebrovascular accidents in history, valvular heart disease, severe rhythm and conduction disorders, endocrine disorders, severe pathologies of the liver and kidneys, receiving systemic glucocorticosteroids actions. All patients underwent a study of pulmonary function (RPF) and SMAD recorders. Applied the following patient classification scheme: “dippers” (Daily index (DI) from 10 to 20%); “nondippers” (DI from 0 to 10%); “overdippers” (DI>20%); “nightpickers” (DI<0). Results: We identified a direct correlation between the level of PBP and age patients with a combination of hypertension and COPD during all monitoring periods (r=0.629, p=0.000 (days), r=0.645, p=0.000 (day), r=0.564, p=0.000 (night)). The same dependence was noted in individuals with hypertension without lung pathology (r=0.298, p=0.021 (days), r=0.266, p=0.04 (day), r=0.346, p=0.007 (night)). Thus, we not only did not identify significant differences in the level of PBP, but also noted general regular features of its dynamics with increasing age of patients of both groups. Comparative assessment of the heart rhythm. DBP also showed significant intergroup differences. Thus, we have established the predominance of “dippers” among patients with AH without lung pathology (51.9%), while among persons with a combination of hypertension and COPD, adequate nocturnal decrease in blood pressure was observed slightly more than in a third of patients (37.4%, p=0.125). Besides, among these patients a significantly higher number of “night pickers” was identified (25% vs. 7.5%, p=0.002), the number of “nondippers” and there were “overdippers” in the compared groups was approximately the same. Conclusions: Presence of COPD in patients with hypertension worsens the course of the latter, which is expressed in a significant predominance of “nightpickers” and “non-dippers” patients.

Peculiarities of the daily profile of blood pressure and heart activity in patients with arrhythmias depending on the severity of cognitive disordersPeculiarities of the daily profile of blood pressure and heart activity in patients with arrhythmias depending on the severity of cognitive disorders

Background. The purpose of our work was to reveal the dependence of changes in the cognitive sphere on the peculiarities of the daily profile of blood pressure (BP) and heart activity in patients with arrhythmias. Materials and methods. We examined 139 patients with different clinical forms of arrhythmias. All of them underwent extended neuropsychological testing, a study of the daily BP profile and heart activity. Hemodynamic status was assessed by daily BP and ECG monitoring. Average daily, average daytime and nighttime systolic (SBP), diastolic blood pressure (DBP) and heart rate (HR) were evaluated. The analysis of spectral indicators of heart rate variability was performed to assess the state of the autonomic nervous system. Correlations of hemodynamic indicators with the results of neuropsychological testing were determined. Results. In patients with cognitive disorders (CD), there was an increase in SBP in all periods of the day, most pronounced in patients with moderate CD (p = 0.049). In patients with mild CD and without CD, there were no significant intergroup differences in the level of average daily, daytime and night SBP, DBP and pulse pressure (p > 0.05). Patients with moderate CD had significantly higher SBP and time index of SBP at the expense of average daytime and average night values of these indicators compared to those without CD (p < 0.05). During the active period of the day, time index of DBP was significantly higher in patients with moderate CD (p = 0.002) who also had an increase in average daily, daytime and night SBP variability compared to participants without CD (p = 0.041). The differences between the groups were not significant in terms of DBP variability (р = 0.07). In 61 (54 %) patients with CD, non-dipper SBP prevailed in the structure of disorders of the daily BP profile, with the highest indicators in moderate CD (55.6 %). The presence of adverse daily DBP profiles — night-peaker (6.2 %) and over-dipper (8.8 %), which prevailed in patients with moderate CD, is hidden behind normal indicators of the daily BP index. Increased average SBP24 (odds ratio (OR) = 3.26, 95% confidence interval (CI): 1.45–5.35, p < 0.001), DBP24 (OR = 3.06, 95% CI: 1.41–4.79, p < 0.001), average HR24 (OR = 2.67, 95% CI: 1.32–4.14, p < 0.001), average SBP24 variability (OR = 2.13, 95% CI: 1.11–3.32, p < 0.001) are the main factors of central hemodynamic disorders that increase the risk of developing CD in patients with arrhythmias. Conclusions. The identified associations between cognitive dysfunction, indicators of daily BP monitoring and heart activity are important in the context of their comprehensive accounting for optimizing an individualized approach to patient management and predicting the development of CD.

The severity of chronic heart failure and the parameters of daily blood pressure profile in patients with coronary heart disease

Aim: Although the prevalence of coronary heart disease (CHD) and hypertension which are the most common causes of the development and progression of chronic heart failure (CHF) is high, 24-hour ambulatory blood pressure (BP) monitoring (ABPM) in patients with CHF is not mandatory to be performed. The growing number of evidence suggests that excessive decrease in BP which clearly reflects increased BP variability (BPV) affects the survival of patients with heart failure (HF). The objective of the study was to investigate the relationship between the parameters specific to CHF severity and features of daily BP profiles in patients with ischemic CHF and hypertension. Methods: Ninety patients with functional class II–IV of CHF and CHD (the main group) and 50 non-CHF patients with hypertension (the comparative group) were examined. The transthoracic echocardiography (TTE) [atrial end-systolic dimension (ESD), ventricular end-diastolic dimension (EDD), left ventricular mass index (LVMI), and left ventricular ejection fraction (LVEF)] and 24-hour ABPM (BPV parameters and proportions of hypotensive episodes) were performed. The relationships between the abovementioned parameters were evaluated using the univariate correlation analysis and stepwise multiple linear regression. Results: Higher functional class of CHF is found to be associated with a higher incidence of daytime systolic BP (SBP) decline and nighttime SBP and diastolic BP (DBP) variability while higher LVEF is related to the hypotensive episodes regardless of CHF. Conclusions: It appears that the larger trials involving CHF patients with reduced LVEF should be conducted to clarify the obtained results.

Features of arterial pressure dynamics according to results of blood pressure monitoring in elderly patients

All over the world, special attention is paid to cardiovascular diseases in patients. According to epidemiological studies, a large contribution to mortality from them is high blood pressure, effective normalization of blood pressure will lead to an increase in life expectancy. The purpose of the study: to study the features of the daily blood pressure profile in elderly patients with hypertension. It was revealed that hypertension in elderly patients is more severe and has significantly higher rates of rise in systolic and diastolic pressure during the day and night hours, high variability, and insufficient (non-dipper) night-time decrease in blood pressure.Therefore, sick groups have a high risk of developing target organ damage, which is a predictor of the development of cardiovascular complications.

Interrelation of daily blood pressure profile with left ventricular myocardial hypertrophy in men of working age with hypertension.

Aim: To analyze the relationship between daily blood pressure biorhythms and left ventricular myocardial hypertrophy in working-age men with arterial hypertension. Materials and Methods: Fifty-seven men with AH (mean age: 44.6±1.3 years) underwent Echo-CG and daily ABPM. Non-dipper and night-peaker patterns indicated BP biorhythm disturbances, while normal dipper and over-dipper patterns indicated undisturbed BP biorhythms. LVH was defined as LMMI > 115 g/m^2. Results: About 60% of participants exhibited diurnal BP rhythm disorders, with a higher prevalence of LVH in this group compared to those with normal BP biorhythms (32% vs. 22%, p>0,05). Patients with normal daily BP biorhythms had significantly higher circadian indices of HR, systolic and diastolic BP, and double product compared to those with disturbed BP rhythms. Conclusions: In young men with "non-dipper" and "night-peaker" patterns, LVH appears to be more pronounced than in those with normal daily BP biorhythms. This approach may optimize the timing of antihypertensive drug administration.

New opportunities for optimizing the treatment of supraventricular heart rhythm disorders in patients with arterial hypertension under conditions of chronic stress

The aim was to determine the effects of Carvelis (Dr Gustav Klein GmbH Co KG, Germany) in patients with arterial hypertension (AH) and supraventricular arrhythmias on the state of psycho‑vegetative disorders in combination with the analysis of heart rate variability (HRV) and manifestations of arrhythmia.
 Materials and methods. Investigation involved 50 patients with АН of ІІ stage 2 degree with supraventricular extrasystole and paroxysmal atrial fibrillation (AF). The first group (26 patients) took standard therapy and Carvelis 30 drops 3 times a day; 24 patients of the second group received the standard therapy only. The examinations were performed before and after 3 months of treatment and included general clinical laboratory examination, questionnaires with psychometric scales, 24‑hours ECG monitoring, daily blood pressure monitoring (DMAT), exercise test (ET), echocardiography.
 Results. At baseline, Hospital Anxiety and Depression Scale (HADS) demonstrated clinically (≥ 11 points) and sub‑clinically (8–10 points) manifested anxiety and depression in all study participants. After 3 months, patients of the 1 group showed significant decrease in the manifestations of anxiety and depression, especially in the most severe cases of psycho‑emotional state. In comparison with the group 2, Carvelis administration was associated with the normalization of HRV indices and an additional 10.8% reduction in the number of AF paroxysms. According to the DMAT data, an almost 2‑fold increase in the number of patients with physiological blood pressure profile and normalization of blood pressure variability indicators was observed in group 1. The treadmill test results demonstrated an increase in power (12.5%) and time (9.5%) of the physical load performed in group 1.
 Conclusions. The use of psychometric scales in patients with arterial hypertension and atrial fibrillation makes it possible to identify psycho‑emotional disorders. Correction of these disorders by addition of Carvelis for 3 months associated with the HRV normalization, increase in the effectiveness of antiarrhythmic therapy, restoration of the physiological daily profile of blood pressure, and increase in the indicators of test with physical load.

Prospective comparative analysis of the ambulatory blood pressure monitoring changes in patients with hypertension after COVID‑19 in the conditions of the Arctic watch

Objective. To conduct a prospective (2-year) comparative analysis of the dynamics of 24-hour ambulatory blood pressure monitoring (ABPM) in patients with arterial hypertension (HTN) and previous COVID-19 infection working in the conditions of the Arctic watch.Design and methods. In the Medical Unit of Gazprom Dobycha Yamburg LLC (GDY) in the polar shift settlement of Yamburg, 347 patients were examined: 222 men (M) and 125 women (W). All of them underwent ABPM according to the standard protocol in 2019 and 2022. Among them, 261 patients had confirmed COVID-19 between 2020 and 2021 and were treated in the Medical Unit of GDY. Among the examined M and W, according to medical history in 2019, 80 % of M (178 from 222 people) and 66 % of W (82 from 125 people) had elevated blood pressure (BP), p = 0,003. Among patients with HTN, 109 M (61,2 %) and 42 W (51,2 %) survived after COVID-19, p = 0,129. They formed observation group (n = 151). Comparison group included HTN patients without COVID-19 (n = 109).Results. In patients with HTN who had COVID-19, ABPM showed an increase in average daily systolic BP (SBP) values after 2 years: from 134,5 (12,3) to 140,5 (11,8) mmHg (p < 0,0001) and diastolic BP (DBP): from 96,6 (14,0) to 105,1 (13,4) mmHg (p < 0,0001), hypertensive load time indices (TI): TI SBP24 (from 49,5 (29,3) to 61,6 (28,1) mmHg (p < 0,0001) and TI DBP24 from 69,3 (30,5) to 83,4 (21,9) mmHg (p < 0,0001), increase in daytime SBP variability (p = 0,048), decrease in daily SBP indices by 1,2 %: from 7,9 (4,6) to 6,7 (4,3) (p = 0,038) and DBP by 2,0 %: from 9,7 (4,8) to 7,7 (4,7) (p = 0,032). Desynchronization of SBP and DBP rhythms were found by chronobiological analysis.Conclusions. A prospective comparative analysis of the dynamics of ABPM in patients with HTN after COVID-19 in the conditions of the Arctic watch showed an increase in the average daily values of SBP and DBP and their daily variability, deterioration in the daily BP profile with an increase in the “night peaker” phenotype. In patients with HTN who did not have COVID-19, a prospective analysis of ABPM showed a significant increase in DBP and average daily hypertensive load of DBP, which may contribute to further cardiovascular remodeling. In patients with HTN who have recovered from COVID-19, desynchronization processes of SBP and DBP rhythms intensify, which requires an in-depth analysis of the chronobiological structure of the rhythm BP.

Cognitive Disorders in Patients with Hypertension: Are There Gender Differences?

Background: Given the profound differences between women and men, there is a need to study gender as a vital variable and factor in blood pressure regulation, control, and treatment. The level of anxiety and depression, which significantly affect the psychological characteristics and patients' quality of life, and the status of the autonomic nervous system represent a rather significant layer of hypertension problems due to its specificity, accumulating its medical, social, gender, and humanitarian aspects, which are related to sexual characteristics.
 Material and Methods: The study results are based on the data of a comprehensive examination of 185 working patients with controlled hypertension (H) stage II. According to the neuro-psychological testing on MMSE, МоСА and Life Quality scales, 157 people with various severity cognitive disorders (CD) were found. There were 87 (55.4 %) women and 70 (44.6 %) men among them, and the average age [M(SD)] was 52.3 (8.2) years; the average duration of H was 10 (8-12 years). The comparison and control groups were adequate for the purpose. The standard methods of parametric and non-parametric statistics processed the obtained data. 
 Results: As a result of the study, significant differences were found in patients with hypertension and CD of both sexes compared with healthy individuals and patients with hypertension without cognitive impairment in relation to the daily blood pressure profile (VAR SBP, VAR DBP) both during the day and at night. The females, even middle-aged, with controlled hypertension but high systolic blood pressure variability, have a substantial risk of developing CD. Male patients with hypertension, even in the absence of CD, are more prone to depression, according to the HADS scale. In the presence of hypertension with CD, they are characterized by significantly worse personal-role physical and emotional functioning compared to female patients on the life quality scale. The often irresponsible attitude of men to the doctor's advice and regular antihypertensive treatment probably plays a significant role in the formation of gender differences in the quality of life of patients with hypertension and CD.
 Conclusion: It is necessary to ensure early diagnosis and monitoring of CD as a marker of brain damage due to hypertension and determine the level of anxiety and depression, which significantly affect the psychological characteristics and quality of life even of patients with controlled hypertension, regardless of gender. However, middle-aged women, even with controlled hypertension but high SBP variability, have a priority risk of CD development.

CHANGES IN THE STRUCTURE OF THE DAILY BLOOD PRESSURE PROFILE IN WOMEN WITH THE METABOLIC SYNDROME WHO HAD CESAREAN SECTIONS UNDER THE INFLUENCE OF PHYSICAL THERAPY

Abstract. Purpose: determination of the effectiveness of the use of physical therapy in women with metabolic syndrome who underwent caesarean section, based on changes in the structure of the daily blood pressure profile.
 Methods. During the research, 44 women aged 25.5±1.6 years at the end of the late postpartum period (2 months after childbirth) were examined. The control group consisted of 17 women with normal body weight who gave birth vaginally and recovered independently in the postpartum period. The comparison group consisted of 14 women with the metabolic syndrome who independently recovered in the postpartum period. The experimental group consisted of 13 women with metabolic syndrome after caesarean section, who for 3 months performed restorative measures developed as part of a proven physical therapy program. They included classes using therapeutic exercises for the muscles of the back, abdomen, and limbs, functional training with adaptation to household movements and child care taking into account obesity and the postpartum period with caesarean section, aerobic training, pressotherapy and vacuum massage for areas with the greatest deposition of fatty tissue; nutritional recommendations – reducing daily caloric intake. Daily monitoring of blood pressure was carried out to determine its profile by the types "diрper", "non-dipper", "over-dipper", "night-peaker".
 Results. During the initial examination, it was established that, in general, women with a normal body weight have a "dipper" daily blood pressure profile. This most favorable type of decrease in arterial pressure at night was characteristic of almost 70% of representatives of this group. At the same time, in women with metabolic syndrome after caesarean section, such a profile was established in slightly more than half of the cases. On the other hand, in the groups of women after caesarean section, a significant share (about a third) was made up of the "non-dipper" and "over-dipper" profiles, which have an unfavorable character. One of the signs of adverse daily dynamics of blood pressure in women with metabolic syndrome is the diagnosis of their circadian rhythm according to the "night-peaker" profile.
 The following results were revealed during the re-survey, which was conducted to assess the effectiveness of the developed physical therapy program. The share of persons with a favorable profile of "dipper" systolic blood pressure increased. This redistribution took place due to the reduction of the share of persons with unfavorable "non-dipper" profiles and the complete disappearance of persons with the daily blood pressure profile "night-peaker" profile. Similar trends were also observed in the analysis of daily diastolic blood pressure profiles.
 Analysis of daily blood pressure profiles of women after vaginal delivery revealed that they had a higher percentage of women with normal profiles in the early periods of observation; further dynamics were favorable. Re-examination of comparison group women showed an increase in the number of women with favorable profiles, but it was not as pronounced as in experimental group women, which demonstrates the benefits of a proven physical therapy program.
 Conclusion. It is advisable to prescribe physical therapy to correct the indicators of the daily profile of blood pressure in women with metabolic syndrome in the postpartum period, which prognostically reduces the risk of cardiovascular disasters in them.

Clinical-functional and nutritional-metabolic features of the comorbid phenotype of vibration disease in combination with arterial hypertension

Introduction. Currently, the occupational etiological factors of vibration disease are well studied, but the management of this group of patients against the background of comorbid pathology, the impact on the quality of life of patients and the long-term prognosis of the disease remains an urgent problem.Aim. Study of nutritional and metabolic status in patients with vibration disease in combination with arterial hypertension.Materials and methods. A survey of 336 patients with vibration disease in combination with arterial hypertension was conducted in the conditions of the regional center of occupational pathology on the basis of a specialized department of occupational pathology. A comprehensive assessment of the clinical, nutritional and metabolic status of patients with vibration disease in combination with hypertension was carried out, including the study of clinical parameters, the daily profile of blood pressure, protein, lipid and carbohydrate metabolism, the component composition of the body of patients and the assessment of the profile of adipokines and cytokines.Results and discussion. Insufficient reduction of pressure at night (non-dippers) was revealed, an increase in fat mass and extracellular fluid was determined against the background of lean mass deficiency and a decrease in phase angle, proatherogenic dyslipidemia, protein deficiency, impaired carbohydrate metabolism, high levels of adipokine and cytokine activity.Conclusion. As a result of the study, additional markers for the diagnosis of nutritional disorders in the combined course of vibration disease and arterial.Conclusions. As an early diagnosis of nutritional and metabolic disorders in vibration disease in combination with arterial hypertension, the most informative integral indicators characterizing nutritional and metabolic disorders in this phenotype were identified – the waist circumference/hip circumference index and active cell mass.

Assessment of daily blood pressure parameters in patients after injury

ABSTRACT. Many studies have highlighted the impact of various significant risk factors on the occurrence of arterial hypertension. However, few papers have examined the effect of psychoemotional factors as important contributors to the risk of arterial hypertension for such a specific population group as contracted servicemen performing military service under conditions of performing special tasks. Furthermore, there is a lack of data on the daily profile of blood pressure in this particular group of individuals. This thesis aims to substantiate the claim that injury, as a risk factor, greatly influences changes in the daily profile of blood pressure. The study examined 118 patients, divided into an experimental group (65 people) and a control group (53 people). The daily profile of blood pressure was assessed using continuous ambulatory blood pressure monitoring. Questionnaires were used to evaluate the quality of sleep, anxiety, and depression. The findings indicated that the patients of the experimental group, following trauma, exhibited a higher index of systolic and diastolic blood pressure duration, while the mean values remained within the normal range. Additionally, these patients more frequently exhibited a blood pressure profile characterized by an insufficient nocturnal decrease in blood pressure, known as non-dipping. This could be attributed to impaired sleep quality, as well as subclinically significant manifestations of anxiety and depression caused by stress. The early detection of changes in the index of systolic and diastolic blood pressure duration, along with deviations in the daily blood pressure profile observed through continuous ambulatory blood pressure monitoring, would enable specialists to promptly address alterations in the hemodynamics of these patients and prescribe appropriate therapy. Therefore, psychoemotional stress in people who have experienced trauma is one of the trigger mechanisms for increased blood pressure. If left unaddressed, this can progress to persistent arterial hypertension.

Daily blood pressure profile and cardiometabolic risk factors in women with newly diagnosed breast cancer

Daily blood pressure profile and cardiometabolic risk factors in women with newly diagnosed breast cancer

FEATURES OF DAILY BLOOD PRESSURE IN PATIENTS WITH ARTERIAL HYPERTENSION WITH CHRONIC KIDNEY DISEASE

Objective: To study the daily profile of blood pressure in patients with arterial hypertension (AH) with chronic kidney disease (CKD). Design and method: The study included 120 patients with AH I-III degree, who received inpatient treatment. CKD stages were determined according to glomerular filtration rate (eGFR), according to the modern KDIGO 2013 classification. Daily blood pressure profile (DAP) was assessed using the Medicom-combi device (Russia). Results: Among the examined patients, preserved renal function of CKD C1 was observed in 20.8% (n = 25); CKD C2 – in 50.8% (n = 61); CKD C3A – in 19.2% (n = 23); CKD C3B – in 9.2% (n = 11) p<0.001. CKD C4 and terminal stages were not detected. It was revealed that according to increasing of degree of CKD, values of the average daily SBP (p = 0.013) average daytime SBP (p = 0.04), mean night SBP (p = 0.001) significantly rises. The load index of elevated daytime and nighttime SBP was high in AH patients with lower eGFR values, p = 0.001. A normal daily profile of SBP/DBP had 28%/32% of patients of the 1st group vs 24.61%/37.70% of patients of the 2nd group vs 37.78%/21.73% of patients of the 3rd group vs 0% /0% of patients of the 4th group, SBP ⇙2 = 40.62 p<0.01; DBP ⇙2 = 47.21, p<0.001. The number of non-dippers in SBP was somewhat higher in the group of patients with CKD C3b: night reduction speed (NRS) SBP 40% in group 1 vs 49.1% in group 2 vs 52.17% in group 3 vs 54.54% in group 4 group ⇙2 = 9.35, p = 0.02. In the group of patients with CKD C3b, individuals with a daily profile of SBP/DBP night-pickers significantly prevailed: 32%/20% vs 14.75%/13.11% vs 13.04%/13.04% vs 45.45%/ 54.54% (in groups 1, 2, 3 and 4, respectively) in SBP ⇙2 = 32.47 p<0.001, in DBP ⇙2 = 64.25 p<0.001. There was a significant increase in patients with a daily profile of over-dipper according to DBP in patients with CKD C3b:0% vs 4.91% vs 13.04% vs 27.27% ⇙2 = 41.47, p<0.001. Conclusions: AH patients with CKD have more pronounced disturbances in the daily blood pressure profile, which contribute to an increased risk of developing complications of arterial hypertension.

DO COGNITIVE FUNCTION IN HYPERTENSION WORSE OR BETTER IN WOMEN OR MEN: ARE COMPARISONS REALISTIC?

Objective: More evidence confirms that cognitive disorders (CD) in hypertension (H) are early signs of cerebral blood flow deregulation and often occur before other target organs are affected. Therefore, assessment and monitoring of cognitive functions in H should be a criterion for the effectiveness of treatment and prognosis of the course of the disease. Design and method: The study results are based on the data of a comprehensive examination of 185 working patients with controlled H stage II with SCORE risk of CVD <5 %. According to the neuropsychological testing on MMSE and MoCA scales, 157 people with various severity CD were found. There were 87 (55.4 %) women and 70 (44.6 %) men among them, and the average age was 52.3 (8.2) years; the average duration of H was 10 (8 - 12 years). The comparison and control groups were adequate for the purpose. The standard methods of parametric and non-parametric statistics processed the obtained data. Results: Significant differences were noted in the parameters of the daily profile of blood pressure (VAR SBP, VAR DBP), both during day and night, in patients with H and CD of both genders due to ambulatory monitoring of BP. According to the data of the correlation analysis, a significant direct correlation of average strength was established between the day and night variability of SBP and DBP and the development of CD in patients with H, regardless of the gender of the patients: with VAR SBP during the day - r = 0.573, with VAR SBP at night - r = 0.614, with VAR DBP during the day - r = 0.426, with VAR DBP at night - r = 0.453. Conclusions: Hypertension is a significant risk factor for the development and progression of CD in both genders. No objective reason to discuss whose gender cognitive functions are worse or better. It is also essential to pay attention to the high autonomic index and variability of blood pressure ambulatory monitored day and night due to the increased risk of development and progression of CD.

CHANGES IN THE NORMAL BP PROFILE IN A PATIENT WITH HYPERTENSION DURING THE WAR IN UKRAINE

Objective: To assess the influence of various external factors and stress due to a large-scale military invasion on the daily blood pressure (BP) profile in the population of patients with arterial hypertension (AH) in Ukraine. Design and method: This was a retrospective analysis of examined patients who underwent ABPM in the last 5 years. We conditionally divided the observation period into several time intervals: the ‘War’ group, the ‘Before the war’ group, the ‘Covid-19’ group, and the ‘Peace’ group, in which each of the 20 patients was selected by the method of random numbers. All patients underwent ABPM using the Watch BP 03 device (Microlife AG, Switzerland). The database was formed, and statistical analysis of the results was carried out using the IBM SPSS 26.0 software package. Results: All groups were comparable according to the age, gender, average daily BP, and heart rate parameters of participants. Patients of all groups were middle-aged, the number of men and women was equal in all groups, and groups were comparable according to the results of average daily SBP, DBP, PBP, and heart rate. We found that the ‘War’ group had a significantly lower percentage of SBP and DBP decrease at night compared to all other groups (7.6 ± 1.3% for SBP and 10.2 ± 1.4% for DBP). The standard deviation of SBP and DBP was significantly higher in the ‘Before the war’ group (19.8 ± 1.1 and 14.2 ± 0.7, respectively) compared to the ‘War’ group (16.0 ± 0.9 and 11 .7 ± 0.6, respectively) and ‘Covid-19’ (16.2 ± 0.7 and 11.8 ± 0.7, respectively). The highest frequency of non-dippers for SBP and DBP was observed in the ‘War’ group (60% and 45% respectively). Conclusions: During the war, the reduction of SBP and DBP at night in patients with hypertension was significantly lower than in the ‘Before the war’, ‘Covid’, and ‘Peace’ groups. There was also a higher number of non-dippers during the war in Ukraine.

FEATURES OF AMBULATORY BLOOD PRESSURE MONITORING WITH DIFFERENT BLOOD PRESSURE PROFILES IN PATIENTS WITH HYPERTENSION DISEASE OF MIDDLE AND ELDERLY AGE

Background. Insufficient night-time reduction of blood pressure (BP) and night hypertension are associated with an increased risk of death regardless of the average daily BP. The study of daily BP profiles is very relevant in patients with hypertension of different age categories due to the high risk of thrombotic complications.
 Aim: of the study was to determine the peculiarities of ambulatory blood pressure monitoring (ABPM) indices in middle-aged and elderly hypertensive patients depending on the daily BP profile.
 Materials and methods. ABPM indicators were determined in 125 patients who were divided into 2 groups. 1st group (n=82) – middle-aged hypertensive patients (45-59 years old); 2nd group (n=43) – elderly hypertensive patients (60-74 years old). In the groups of middle-aged and elderly subjects 2 groups of daily BP profiles were distinguished: "dipper" and "non-dipper".
 Indices of ABPM were determined using a portable recorder ABPM-04 (company "Meditech", Hungary). Measurements of BP were performed every 15 minutes during the day (from 6 to 22 hours) and every 30 minutes at night (from 22 to 6 hours). We determined the following indices: the average daily systolic BP (SBP) (mm Hg), the average daly diastolic BP (DBP) (mm Hg), the average BP (mm Hg); the maximal daily SBP (mm Hg), the maximal daily DBP (mm Hg). The daily index (DI) was also calculated − the percentage of BP decrease at night compared to daytime BP calculated in % DI of SBP, DI of DBP, DI of average BP.
 Results. The baseline BP level in the average daily SBP and DBP in middle-aged patients of dipper group was significantly higher by 49,6% and corresponded to 155,9±12,0 mm Hg (p<0,001) and 50,4% and was 97,3±6,1 mm Hg (p<0,01). Similar results are observed in the average BP and the maximal daily SBP and the maximal daily DBP values which were significantly higher than the control group by 21,5% (p<0,05) and equaled 110,0±3,6 mm Hg and 21,3% and amounted to 176,3±23,5 mm Hg (p<0,05) and 23,6% and amounted to 117,0±19,2 mm Hg (p<0,05). The baseline BP level in the average daily and maximal SBP, the average daily DBP and the average BP in patients of non-dipper group was significantly higher by 50,8% (p<0,01) and corresponded to 157,1±12,9 mm Hg and 27,4% and equal to 176,9±24,0 mm Hg (p<0,05), 63,8% and amounted to 106,0±1,0 mm Hg (p<0,05) and 44% and was 124,3±6,8 mm Hg (p<0,05) too. In the surveyed elderly patients only the average daily DBP was significantly different from the corresponding control indicator and was lower by 21,4% (p<0,05) and amounted to 91,5±0,7 mm Hg in dipper and 23,1% (p<0,01) and was 93,5±0,7 mm Hg in non-dipper group.
 Conclusion. Non-dipper group predominates in the structure of daily BP rhythm in elderly hypertensive patients (62,8% versus 37,2%). The average BP decreases in elderly patients of non-dipper group by 11,1% (p<0,05) reliably to patients of middle age.

Prognosis and risk factors for the adverse course of the disease in patients with arterial hypertension and its resistant form

Arterial hypertension (AH) is expected to contribute to approximately 13% of all deaths worldwide in the coming years. Objective — to perform retrospective analysis of the factors of the adverse course of the disease in patients with hypertension who were treated in a specialized department for secondary and pulmonary hypertension of the «NSC M. D. The Strazhesko Institute of Cardiology, Clinical and Regenerative Medicine » NAMS of Ukraine. Materials and methods. The analysis involved data from 524 patients who underwent the following standard examinations: measurement of office blood pressure (BP), 24h‑hours BP monitoring, echocardiography, electrocardiography. All patients received a questionnaire in five years after discharge from the hospital. It included questions about previous adverse events (myocardial infarction, stroke, unstable angina that required hospitalization, kidney failure, heart failure, newly diagnosed diabetes, hospitalization for another cardiovascular reason (aortic aneurysm, coronary artery bypass grafting, unstable angina pectoris, etc.). In case of death of a patient, relatives filled in the questionnaire. Adverse events or death were considered as a combined end point (CEP) of the study. Results. The following main factors, associated with the CEP occurrence in the examined patients, have been established: the age of the patient, systolic blood pressure level at discharge from the hospital, the level of pulse blood pressure (PBP) at discharge from the hospital, the presence of postinfarction cardiosclerosis, a history of stroke, increased size of the left atrium, reduced ejection fraction of the left ventricle, increased thickness of the interventricular septum, left ventricular myocardial mass index greater than 137 g/m2, disturbed daily profile of diastolic blood pressure (DBP), average daytime PBP level ≥ 64 mm Hg. The following risk factors were independent from other factors of CEP occurrence: the level of office PBP at discharge from the hospital ≥64 mmHg, reduced ejection fraction of the left ventricle ( 40%), thickening of the interventricular septum >1.2 cm, the mass index of the left ventricle > 137 g/m2, a decrease in BP during the night period<10%, average daytime BP during daily monitoring blood pressure ≥64 mmHg. Among the indicated factors, the following factors didn’t depend on the administered therapy: office PBP level ≥64 mmHg at discharge, left ventricular ejection fraction reduced by <40%, violation of the daily blood pressure profile (daily blood pressure index <10%) or average daily blood pressure higher than 64 mm Hg. Factors that significantly increased the CEP risk included systolic blood pressure level ≥160 mmHg (patients with resistant AH) and PBP ≥64 mmHg at discharge from the hospital; the CEP risk was increased by these factors was 84 and 66%, respectively. No significant effects on the frequency of occurrence of the combined end point were established for any group of antihypertensive drugs. Conclusions. Treatment‑resistant hypertension was a determining factor in the development of the combined end point. The degree of arterial pressure decrease was more significant for prognosis than the type of antihypertensive agent that lowered it.

The Daily Profile of Blood Pressure in Patients with CKD of Various Stages

The Daily Profile of Blood Pressure in Patients with CKD of Various Stages