Comparative characteristics of indicators of peripheral arterial and central aortic pressure, remodeling of the left ventricular myocardium in salt-sensitive and salt-resistant patients with arterial hypertension

Background. Changes in the vascular wall, in particular, an increase in its stiffness and an increase in pressure in the aorta, as well as hypertrophy of the left ventricular myocardium are factors that determine a poor prognosis in patients with arterial hypertension. At the same time, the peculiarities of changes in arterial stiffness indices and left ventricular myocardial remodeling in patients with different sensitivity to salt loading have not been adequately studied. Aim. To conduct a comparative analysis of the values of peripheral blood pressure and central aortic pressure, indicators of left ventricular myocardial remodeling in salt-sensitive and salt-resistant patients with arterial hypertension. Materials and methods. The study involved 180 patients with arterial hypertension: 96 men and 84 women. The median age was 59 years. Salt sensitivity test was performed according to V.I. Kharchenko. All patients underwent 24-hour blood pressure monitoring, echocardiography. Indicators of peripheral arterial pressure and central aortic pressure, remodeling of the left ventricular myocardium were determined. Results. According to the results of the test V.I. Kharchenko, 88 patients were classified as salt-sensitive, 92 as salt-resistant. After a salt sensitivity test in salt-sensitive patients, the main indicators of peripheral blood pressure and central aortic pressure exceeded those in salt-resistant patients in the daytime, at night, and throughout the day as a whole. In the group of salt-sensitive individuals, statistically more significant negative changes in echocardiographic parameters were recorded; a significant number of salt-sensitive patients were diagnosed with prognostically unfavorable variants of left ventricular myocardial remodeling. Conclusion. In salt-sensitive patients with arterial hypertension, compared with salt-resistant patients, there are higher values of both peripheral blood pressure and central aortic pressure, more significant negative changes in echocardiographic parameters with the formation of concentric hypertrophy and eccentric remodeling of the left ventricular myocardium. It can be assumed that the assessment of salt sensitivity makes it possible to verify patients with the most unfavorable changes in parameters of ambulatory blood pressure monitoring and significant remodeling of the left ventricular myocardium. This approach can be used to individualize pharmacotherapy in patients with arterial hypertension and increase its effectiveness.

АRTERIAL STIFFNESS AND CENTRAL AORTAL PRESSURE AS SIGNIFICANT PREDICTORS OF COMPLICATIONS AFTER OFF-PUMP CORONARY ARTERY BYPASS GRAFTING

Some studies have shown that an increase in arterial stiffness and central aortic pressure increase the risk of postoperative complications for off-pump coronary artery bypass grafting (off-pump CABG). AIM: To determine the significance of arterial stiffness and central aortic pressure indicators for predicting acute kidney injury (AKI) and cardiac events in patients after off-pump CABG. MATERIALS AND METHODS: An analysis of off-pump CABG outcomes was carried out in 196 patients (mean age 62.7 ± 5.3 years) without clinical signs of chronic kidney disease. The patients were divided into a test (n = 56) and control (n = 140) groups, depending on the presence or absence of AKI, acute coronary syndrome (ACS), or cardiac arrhythmias in the early postoperative period. Pulse wave velocity indicators (PWV) were processed on the carotidfemoral (cf PWV) and brachio-ankle (baPWV) segments, and the results of measuring central aortic pressure (CAP). RESULTS: It has been proven that the incidence of AKI is significantly higher in patients with higher cf PWV (n <0.001), baPWV (n = 0.034) and systolic aortic pressure (SAP) (n = 0.013). ACS was more often observed in patients with higher SAP (n <0.001) and diastolic (DAP) (n = 0.005) aortic pressure, and cardiac arrhythmias in patients with higher SAP and office systolic pressure (n < 0.001). Based on the results of logistic regression analysis, it was determined (by regression coefficients — B) that an increase in cf PWV by 1 m/s increases the risk of AKI by 85.0%. An increase in SAP by one unit significantly increases the risk of ACS by 111.0% and cardiac arrhythmias by 58.0%. It was shown that the measurement of CAP has a greater diagnostic value than the office measurement of blood pressure. CONCLUSION: Arterial stiffness is an independent predictor of AKI for off-pump CABG. A decrease in PWV value is accompanied by a decrease in the incidence of AKI. CAP indices have a more significant prognostic value with respect to the likelihood of cardiac events after an off-pump CABG than the data of measurement of blood pressure.

PREVALENCE OF OBESITY IN WOMEN OF DIFFERENT AGES AND ITS RELATIONSHIP WITH ARTERIAL STIFFNESS

Objective: to study the relationship of obesity with arterial stiffness and dynamics of central aortic pressure in women of different ages with preserved and lost reproductive function. Materials and methods: 161 women were examined, who were divided into 3 groups. Two groups with preserved reproductive function: group 1 consisted of 52 young women from 18 to 30 years old (23.85.3 years); group 2 - 54 women aged from 31 to menopause (415.9 years). Group 3 included 55 postmenopausal women (55.45.8 years). All women underwent a clinical examination with anthropometry; questioning; 24-hour monitoring of the dynamics of blood pressure with the determination of indicators of arterial stiffness and daily aortic central pressure; determination of the carotid-femoral pulse wave velocity (cfPWV); study of vascular stiffness by volume sphygmography. Results: women in groups 2 and 3 were comparable in terms of the prevalence of general obesity (GO). Abdominal obesity (AO) was detected in 19.2% of the 1st group; 51.9% of the 2nd and 76.4% of the 3rd group. In 1st group AO has the strongest relationship with aortic pulse wave velocity PWVao (R=0.41, p=0.002) and the corrected to HR75 augmentation index Aixao (R=0.38, p=0.005). In 2nd group AO correlates with cfPWV (R=0.4, p=0.003); GO with PWVao (R=0.38, p=0.005) and aortic cardio-ankle vascular index CAVIao (R=0.48, p=0.001). In the 2nd group AO and GO are also interconnected with central and peripheral pressure. In 3rd group AO correlates with PWVao (R=0.33, p=0.01), cfPWV (R=0.32, p=0.02); GO with the index of the double product IDP (R=0.36, p=0.01). Conclusion: it is necessary to conduct a comprehensive assessment of arterial stiffness and daily dynamics of central aortic pressure in women of all ages, suffering from obesity and, first of all, its abdominal type, in order to early diagnosis of subclinical changes in the vascular wall and central hemodynamic disturbances.

Determinants of central aortic pressure and pulse pressure amplification changes in patients with aortic aneurysm: the role of aortic diameter and aortic aneurysm location level

Background The presence of aortic aneurysm can alters pulse wave propagation and reflection, causing changes in central aortic pressure and pulse pressure amplification (PPA) between the aorta and the brachial artery that might be associated with unfavorable hemodynamic effects for the central arteries and the heart. However, the impact of the location of the aneurysm and increase of the aortic diameter on central blood pressure (CBP) is not fully understood. Objective To investigate central aortic pressure and PPA regarding to association with arterial stiffness and aortic diameter in patients with ascending aortic aneurysm (AA), descending thoracic and abdominal aortic aneurysm (TAA and AAA). Methods 122 patients (96 males, 65±11 years) with aortic aneurysm were enrolled before aortic repair. The parameters of the aorta were evaluated by MSCT angiography: 44 patients (30 males, 55±13 years) had AA (the maximum diameter: 59.9±14.2 mm), 13 patients (11 males, 62±11 years) had TAA (the maximum diameter: 62.8±8.0 mm) and 65 patients (54 males, 69±8 years) had AAA (the maximum diameter: 52.3±17.2 mm). Brachial blood pressure (BBP) was measured by OMRON. CBP, augmentation index (AIx), carotid-femoral pulse wave velocity (PWV) were assessed by SphygmoCor. PPA was calculated as a difference between the values of central and brachial pulse pressure (CPP and BPP). Results Patients of the three groups did not differ in BPP (AA: 59.2±17.6; TAA 56.8±12.8; AAA: 59.3±11.4 mm Hg; P=0.5). Intergroup comparison revealed a difference in CPP between the three patients groups: CPP was higher in patients with AA and AAA, lower in patients with TAA (AA: 50.3±16.2; TAA 43.8±10.8; AAA: 50.0±11.2 mm Hg; P=0.05). PPA was lower in patients with AA and AAA than in patients with TAA (9.6±6.7 and 9.3±4.2 vs. 13.0±6.5 mm Hg; P=0.05 and P=0.04, respectively). IAx was higher in patients with AA and AAA than in patients with TAA (25.2±8.1 and 27.6±8.2 vs. 17.2±8.2 mm Hg; P=0.008 and P=0.001, respectively). A decrease of PPA across all patients correlated with an increase of IAx (r = - 0.268; P=0.003). CPP decreased with an increase of the aortic diameter for each level of the aneurysm (AA: r = - 0.460, P=0.016; TAA: r = - 0.833, P=0.003; AAA: r = - 0.275, P=0.05). PWV decreased with the expansion of the maximum aortic diameter at the level of the AA, TAA and AAA: (r = - 0.389, P=0.03; r = - 0.827, P=0.02 and r = - 0.350, P=0.01, respectively). Conclusion In patients with aortic aneurysm measurements of lower central pulse pressure and reduced PWV indicate an association with increased diameter of the aneurysm. An increase in augmentation index, early return of reflected waves, thus smaller PP amplification and higher CPP were identified in patients with ascending and abdominal aortic aneurysm compared by patients with descending thoracic aortic aneurysm. Funding Acknowledgement Type of funding source: None

Is 24 hour central aortic pressure superior to single measurement of central aortic pressure in well controlled hypertensive patients

Background Non-invasive measurements of 24 h ambulatory central aortic systolic pressure (24hCASP) is now feasible method than single measurement of CASP. There is growing interest in CASP as cardiovascular risk marker beyond conventional brachial blood pressure (BP). Pulse wave velocity estimates arterial stiffness, whereas CASP is representative of the BP in major organs. Purpose To evaluate non- invasive parameters for arterial stiffness using oscillometric method and to compare 24hCASP with single measurement of CASP in well-controlled hypertensive patients to detect target organ damage (TOD). Methods A total 95 patients (57±14 years) with hypertension, were separated in two groups: 22 patients with normal EA/Ees ratio (Arterial elastance (EA) and ventricular elastance (Ees)) and 73 hypertensive patients with decrease EA/Ees ratio, marker for ventriculo-arterial coupling. EA and Ees were calculated as and – systolic pressure/stroke volume and end-systolic pressure/end-systolic volume. Parameters for arterial stiffness – 24hCASP, ambulatory central systolic pressure (CASP), 24-hour pulse wave velocity (PWV24h) and ambulatory PWV were measured non-invasively with oscillometric method by Mobil-O-graph PWA. Results Statistically significant differences in parameters of vascular stiffness were found in patients with normal ventriculo-arterial coupling in comparison with disturbed EA/Ees: 24hCASP (107.64±9.19 vs. 116.64±16.7 mm Hg, p=0.02), CAP (117.45±9.26 vs. 128.42±16.15 mm Hg, p&lt;0.0001). There were no statistically significant differences in PWV and PWV24h. Multiple regression analysis demonstrated that CAP (B=−0.264 p=0.003; 95% CI: −0.003–0.014) is independent predictor of TOD in hypertensive patients, than 24 hour central aortic pressure. Conclusion There is no superiority of 24hCASP than single measurment of CASP. CASP could predict preclinical damage and cardiovascular outcome. Funding Acknowledgement Type of funding source: None