The Relationship between the Parameters of Blood Pressure Variability and Arterial Wall Stiffness in Patients with Arterial Hypertension

Introduction. According to Akl C et al. by 2025, the number of people with arterial hypertension (AH) will increase by 15–20% and reach 1.5 billion people. Since hyperuricemia (HU) is closely related to other AH risk factors, there is a need to study the relationship between HU and other AH risk factors. Objective of this work is to develop rational approaches to modifying individual AH risk factor using intravenous laser therapy (IVLT). Materials and methods. The study included 184 people: Group 1 (n = 30) – normotensive individuals without HU; Group 2 (n = 52) – normotensive patients with HU; Group 3 (n = 48) – patients with essential AH (stage I, 1-2 degree) without HU; Group 4 (n = 54) – patients with essential AH (stage I, 1-2 degree) with HU. Patients in Group 3 and 4 were divided into subgroups according to the treatment regimens: 3A (n = 24), 4A (n = 26) (standard antihypertensive therapy (AHT)) and 3B (n = 24), 4B (n = 28) (combination treatment with AHT and IVLT). The IVLT course was performed with a wavelength of 635 nm, a power of 1.5 mW, a radiation power density of 0.2 W/cm2, a fluence of 0.2 J/cm2, an exposure of 900 seconds, the course – daily, with a total of 10 procedures. Study results. The association between the level of uric acid (UA), systolic blood pressure (SBP), diastolic blood pressure (DBP), endothelial dysfunction (ED), left ventricular myocardial dysfunction, excess increase in arterial wall stiffness, and poikilocytosis in the study groups was established. The use of IVLT in combination with AHT allows to achieve a statistically significant (р < 0.05), compared to AHT reduction in SBPd by 4.2%, DBPd by 2.4%, DBPn by 2.5%, time index (TI) SBPd by 5.1%, TI DBPd by 2.7%, TI SBPn by 19%, rate of morning rise (RMR) SBP by 33.8%, RMR DBP by 31%, early morning blood pressure surge (EMBPS) SBP by 17.3%, EMBPS DBP by 12.8%, puilse wave velosity (PWV) by 4.1%, manifestations of endothelial dysfunction by 1.4%, myocardial dysfunction by 4.5%, poikilocytosis by 2.9%, uric acid level by 3.1% in patients with AH. In AH and HU comorbidity, addition of ILT to AHT allows to achieve an additional reduction in SBPd by 9.3%, DBPd by 7.4%, SBPn by 11,5%, DBPn by 2.7%, TI SBPd by 18.8%, TI DBPd by 18.9%, TI SBPn by 1.8%, TI DBPn by 8,7%, RMR SBP by 25.8%, RMR DBP by 28.5%, EMBPS SBP by 8.2%, EMBPS DBP by 6.0%, PWV by 13.4%, endothelial dysfunction by 3.5%, myocardial dysfunction by 18.8%, poikilocytosis by 5.7%, uric acid level by 11.6% compared to AHT. In patients with normal blood pressure and HU values, the use of IVLT can reduce DBPM, EDVD, poikilocytosis, and UA level parameters (p < 0.05). Conclusions. The presence of direct correlations of average strength between HU and endothelial dysfunction, systolic diastolic dysfunction, excessive increase in arterial wall stiffness, and poikilocytosis was found. The use of IVLT in normotensive and hypertensive patients with AH with an effective method of UA level correction, excessive arterial wall stiffness, myocardial dysfunction, ED and poikilocytosis.

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Association between H-type arterial hypertension and vascular stiffness (a pilot study)

Zaporozhye Medical Journal ◽

10.14739/2310-1210.2021.1.224862 ◽

2021 ◽

Vol 23 (1) ◽

pp. 32-41

Author(s):

Yu. M. Sirenko ◽

O. L. Rekovets ◽

O. O. Torbas ◽

S. M. Kushnir ◽

O. Yu. Sirenko

Keyword(s):

Blood Pressure ◽

Arterial Stiffness ◽

Arterial Hypertension ◽

Blood Pressure Level ◽

Vascular Wall ◽

Vascular Stiffness ◽

Wall Stiffness ◽

Body Weights ◽

Total Homocysteine ◽

The Relationship

Increased arterial stiffness is an important determinant of cardiovascular risk. Elevated total homocysteine (HC) levels appeared to be an independent risk factor for cardiovascular disease (CVD). To date, clinical studies on the relationship between HC and pulse wave velocity (PWV) assessment have shown conflicting results. Aim. To estimate the prevalence of hyperhomocystinemia (HHc) among patients with mild to moderate arterial hypertension and the effect of HHc on the vascular wall stiffness. Materials and methods. Our study was carried out as a part of the HYPSTER study in Ukraine. The study included 40 patients with I and II degree of arterial hypertension (AH) (average office systolic blood pressure (SBP)/diastolic (DBP) – 155.88/92.60 ± 1.63/1.43 mm Hg), heart rate – 71.40 ± 1.29 beats/min. The average age of the patients was 55.85 ± 2.09 (26–74) years. Patients with HC levels ≥10 μmol/l were defined as patients with H-type AH (HHc). Arterial stiffness was determined by PWV. Results. We found that at the beginning of the study, 75 % (30 patients with mild and moderate hypertension) had H-type hypertension with an increased level of HC. Patients with H-type AH and AH patients without HHc did not differ in age and AH duration. At the same time, patients with H-type AH had higher body weights and BMI. Office SBP in patients with H-type hypertension was higher compared to patients without HHc (156.45 ± 1.04 mm Hg vs. 152.55 ± 1.41 mm Hg at the beginning (P < 0.05) and 130.65 ± 0.96 mm Hg vs. 126.97 ± 1.08 mm Hg after 6 months (P < 0.05)) of treatment, respectively. BMI in H-type AH was 30.72 ± 0,39 kg/m2 vs. 28.34 ± 0.69 kg/m2 without HHc (P < 0.05) at the beginning of the study. It was difficult to achieve target levels of BP in the patients with H-type hypertension during the treatment and they had high initial blood pressure values. In contrast to the patients without HHc, H-type AH patients had a more pronounced degree of insulin resistance (according to the HOMA index), lower GFR both at the beginning and at the end of the treatment. According to ambulatory BP monitoring, H-type AH patients presented with a significantly higher SBP level before starting the treatment compared to those with AH without HHc. The regression analysis revealed an association between HC and PWVel, regardless of the degree of BP reduction (PWVel (6 months), m/s, β = 0.307, P = 0.001). Conclusions. Hyperhomocystinemia was observed in 75 % of patients with arterial hypertension. Homocysteine levels were associated with vascular stiffness, regardless of the reduction in blood pressure level.

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VARIABILITY OF BLOOD PRESSURE IN COMORBIDITY OF ARTERIAL HYPERTENSION AND ATRIAL FIBRILLATION

Journal of the Grodno State Medical University ◽

10.25298/2221-8785-2021-19-5-481-488 ◽

2021 ◽

Vol 19 (5) ◽

pp. 481-488

Author(s):

S. S. Boev ◽

◽

N. Ya. Dotsenko ◽

I. A. Shekhunova ◽

L. V. Gerasimenko ◽

...

Keyword(s):

Atrial Fibrillation ◽

Blood Pressure ◽

Risk Factor ◽

Cardiovascular Risk ◽

Arterial Hypertension ◽

Blood Pressure Variability ◽

Decisive Role ◽

Additional Contribution ◽

The Relationship ◽

Risk Reducing

Background. Arterial hypertension plays a decisive role in the development of atrial fibrillation, being the most important risk factor. Purpose. Analyze the literature on modern concepts of the relationship between blood pressure variability and atrial fibrillation. Material and methods. We analyzed 53 literature sources. Results. Information about the modern mechanisms of atrial fibrillation formation in arterial hypertension has been obtained. Approaches to the choice of antihypertensive therapy in patients with arterial hypertension and atrial fibrillation have been described. Conclusions. Based on the studies presented in the literature, it was found that blood pressure variability has an additional contribution to cardiovascular risk. Reducing blood pressure variability can be added as one of the important strategies in the treatment of arterial hypertension and atrial fibrillation.

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Blood pressure level and laboratory indicators of disease severity in patients with arterial hypertension and COVID-19

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.166 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

K Popov ◽

A Novitskiy ◽

Y Shvarts

Keyword(s):

Blood Pressure ◽

Multivariate Analysis ◽

Arterial Hypertension ◽

Negative Correlation ◽

Diastolic Pressure ◽

Negative Relationship ◽

Laboratory Parameters ◽

Acute Period ◽

Nonparametric Correlation ◽

The Relationship

Abstract Funding Acknowledgements Type of funding sources: None. Background. Many patients with COVID-19 suffer from arterial hypertension and have marked variations in blood pressure (BP) during the acute period of infection. The reasons for such changes are poorly understood. Purpose. To assess the relationship between the level of BP and the severity of changes in the main clinical and laboratory parameters in patients with arterial hypertension and with a moderate course of COVID-19 at the stage of the height of the disease. Materials and methods. The study included 86 hospitalized patients with verified coronavirus disease of moderate severity: 46 of them were male, the median age was 65 years. Patients received adequate hypertension therapy for a long time. After hospitalization, treatment was adjusted if necessary. The level of laboratory parameters in the acute period of the disease was determined, including the electrolytes, C-reactive protein (CRP), albumin, ferritin, general blood test, etc. BP measured daily. The relationship between laboratory parameters and BP level was evaluated by nonparametric correlation using the Spearman coefficient and multivariate analysis based on the "generalized nonlinear model". Results. In 67.44% of patients with hypertension, an elevated BP level (>140/90) was observed against the background of moderate COVID-19. There was a significant negative correlation between the levels of CRP and BP throughout the stay in the hospital, the most significant is the 5th day of hospitalization. At the same time, a slightly stronger relationship is observed with diastolic BP (r = -0.4425) than with systolic BP (r = -0.3525). A similar trend is observed in all BP measurements. Besides, a negative correlation was found between potassium levels and BP values. The strongest association of potassium levels is with systolic BP on the day of hospitalization (r = -0.4850) and diastolic pressure on the 1st day of hospitalization (r = -0.3561). Multivariate analysis confirmed independent and reliable "influence" of CRP (p = 0.00018) and potassium (p = 0.03921) as independent predictors of diastolic pressure. Conclusions. Most patients with hypertension and moderate COVID-19 have elevated BP levels. There is a statistically significant negative relationship between the values of BP and levels of CRP and potassium. The obtained data may correspond to the existing hypothesis about the significant role of the kinin–kallikrein system in the pathogenesis of COVID-19.

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THE RELATIONSHIP BETWEEN EARLY BLOOD PRESSURE VARIABILITY AND SHORT-TERM PROGNOSIS IN SEVERE TRAUMATIC BRAIN INJURY PATIENTS

Heart ◽

10.1136/heartjnl-2012-302920r.15 ◽

2012 ◽

Vol 98 (Suppl 2) ◽

pp. E255.4-E256

Author(s):

Chen Hui ◽

Wu Xiaoying ◽

Chen Hui

Keyword(s):

Blood Pressure ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Severe Traumatic Brain Injury ◽

Blood Pressure Variability ◽

Short Term ◽

The Relationship

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The relationship between ambulatory blood pressure variability and enlarged perivascular spaces: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2016-015719 ◽

2017 ◽

Vol 7 (8) ◽

pp. e015719 ◽

Cited By ~ 16

Author(s):

Shuna Yang ◽

Wei Qin ◽

Lei Yang ◽

Huimin Fan ◽

Yue Li ◽

...

Keyword(s):

Blood Pressure ◽

White Matter ◽

Ambulatory Blood Pressure ◽

Blood Pressure Variability ◽

Cross Sectional Study ◽

Perivascular Spaces ◽

Spearman Correlation ◽

Sectional Study ◽

Cross Sectional ◽

The Relationship

ObjectivesRecent studies reported that 24-hour ambulatory blood pressure variability (ABPV) was associated with lacunar infarction and white matter hyperintensities (WMH). However, the relationship between ABPV and enlarged perivascular spaces (EPVS) has not been investigated. Thus, our study aimed to investigate whether ABPV is associated with EPVS by 24-hour ambulatory blood pressure monitoring (ABPM).DesignWe conducted this study as a cross-sectional study.SettingsThe study was based on patients who presented for physical examinations in our hospital from May 2013 to June 2016.ParticipantsPatients with both brain MRI scans and 24-hour ABPM were included and patients with acute stroke, a history of severe stroke and some other severe diseases were excluded. A total of 573 Chinese patients were prospectively enrolled in this study.Primary and secondary outcome measuresEPVS in basal ganglia (BG) and white matter (WM) were identified on MRI and classified into three categories by the severity. WMH were scored by the Fazekas scale. Coefficient of variation (CV) and SD were considered as metrics of ABPV. Spearman correlation analysis and ordinal logistic regression analysis were used to assess the relationship between ABPV and EPVS.ResultsThere were statistical differences among the subgroups stratified by the severity of EPVS in BG in the following ABPV metrics: SD and CV of systolic blood pressure (SBP), CV of diastolic blood pressure (DBP) in 24 hours, daytime and nighttime and SD of DBP in nighttime. The above ABPV metrics were positively associated with the degree of EPVS. The association was unchanged after adjusting for confounders. Spearman correlation analysis showed ABPV was not related to the degree of EPVS in the WM.ConclusionABPV was independently associated with EPVS in BG after controlling for blood pressure, but not in the WM. Pathogenesis of EPVS in BG and WM might be different.

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Effect of chronic ANG I-converting enzyme inhibition on aging processes. II. Large arteries

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.1994.267.1.r124 ◽

1994 ◽

Vol 267 (1) ◽

pp. R124-R135 ◽

Cited By ~ 19

Author(s):

J. B. Michel ◽

D. Heudes ◽

O. Michel ◽

P. Poitevin ◽

M. Philippe ◽

...

Keyword(s):

Blood Pressure ◽

Smooth Muscle ◽

Arterial Wall ◽

Left Ventricular ◽

Structure And Function ◽

Wall Structure ◽

Large Artery ◽

Converting Enzyme ◽

Wall Stiffness ◽

And Function

The consequences of hypertension and aging on cardiovascular structure and function are reputed to be similar, suggesting that blood pressure plays a role in the aging process. However, the exact relationship between aging, blood pressure, and the arterial structure-function relationship has not been demonstrated. To test the effects of aging, renin-angiotensin system, and pressure on the arterial wall, 20 normotensive male WAG/Rij rats were killed at 6, 12, 24, and 30 mo of age and compared with similar groups treated with an angiotensin (ANG)-converting enzyme inhibitor (ACEI), perindopril. Arterial function was determined by a systemic hemodynamic study and by in situ measurement of carotid compliance. Arterial wall structure was determined by histomorphometric and biochemical methods. Aging did not significantly modify blood pressure, but ACE inhibition decreased blood pressure significantly from 6 to 30 mo. Plasma renin activity decreased with age and increased with ACEI. Plasma atrial natriuretic factor increased with age and was significantly decreased with ACEI. Absolute and relative left ventricular weight increased with age, and ACEI delayed these increases. Arterial wall stiffness increased with age, as shown by a significant decrease in systemic and local arterial compliance and by an increase in aortic characteristic impedance. The increase in carotid wall compliance after poisoning of smooth muscle contractile function (KCN) was greater in young (6- and 12-mo old) than in old (24- and 30-mo old) rats. Chronic ACEI treatment increased basal carotid compliance values slightly and did not change KCN carotid compliance. The aortic and carotid luminal size increased regularly with age. Aging was associated without any change in absolute elastin content. In contrast, collagen content increased with aging. Aging was also associated with an increase in medial thickness. Medial thickening was mainly due to smooth muscle hypertrophy. Aging was associated with intimal proliferation, which became progressively thicker and collagen rich. ACEI treatment did not prevent aortic lumen enlargement but significantly postponed the increase in medial and intimal thickening. Biochemical determinations of the aortic wall components confirmed the morphometric data. In conclusion, the age-dependent large artery enlargement and stiffening were observed both in normotensive rats and in those rats whose blood pressure was lowered by ACEI. This suggests that aging and blood pressure affect arterial wall structure and function by different mechanisms.

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