Cardiovascular aspects and the state of vegetative balance in patients with arterial hypertension associated with dyslipidemia
DOI:
https://doi.org/10.14739/2310-1210.2017.5.110083Keywords:
hypertension, blood pressure, cardiac remodeling, autonomic regulation, dyslipidemiaAbstract
Objective. The aim of this study was to investigate the effect of dyslipidemia on cerebral and intra-cardiac hemodynamics, heart and blood vessels remodeling and the state of vegetative balance in patients with hypertension.
Materials and Methods. 100 patients with stage II arterial hypertension (AH) were examined. Depending on the total cholesterol (TCh) level, all patients were divided into two groups: the group I included 69 patients with AH and hypercholesterolemia (HCE), the group II - 31 patients without HCE. All patients were subjected to the evaluation of DMAР, echocardiography, duplex pulsed-wave Doppler extracranial vessels, heart rate variability (HRV) according to the Holter monitoring of ECG.
Results. TCh levels over 5 mmol/L were observed in 69% of patients with AH. Hypertensive patients with HCE and patients with normal level of TCh did not differ from each other in all indicators of "office" blood pressure, LV systolic and diastolic function parameters and pressure in LA. Patients with AH associated with HCE had a significantly larger LA size in systole by 10.8% and diastole by 6.9%, and the thickness of IVS in systole by 13.33%. There was a significant decrease in the maximum linear velocity of blood flow in both CCAs by 11%, in both VAs by 16%, in BA by 12.9%, as well as a reliable decrease in the vascular reactivity index of sensitivity to hypercapnia in BA by 15.1% in the group I. Patients of both groups did not differ in all time and spectral indices of HRV, however, hypertensive patients with HCE had increased activity of the sympathetic nervous system, as demonstrated by the LF/HF index of more than 2 CU.
Conclusions. The presence of hypercholesterolemia in patients with AH does not affect significantly the level of blood pressure, but affects the parameters of cardiac remodeling, and also has an effect on the cerebral blood flow and the state of vegetative balance.
References
Khurs, E. M., Zinov´eva, Yu. A., Poddubnaya, A. V., & Smolenskaya, O. G. (2008). Dinamika zakonomernostej patologicheskogo remodelirovaniya serdca po dannym EhoKG: gran´ mezhdu adaptaciej i patologicheskoj napravlennost´u processa [Dynamics of regularities of pathological cardiac remodeling according to EchoCG data: the line between adaptation and pathological orientation of the process]. Ul´trazvukovaya i funkcional´naya diagnostika, 2, 91. [in Russian].
Dorohoi, A. P. (2011). Termіn vykonannia «Programy profіlaktyky і lіkuvannia arterіalnoi hіpertenzіi v Ukrainі» zakіnchyvsia, problemy zalyshylysia. Shho dalі? [The term "Program for the prevention and treatment of arterial hypertension in Ukraine" has expired, problems have remained. What's next?]. Arterial'naya gipertenziya, 3(17), 29–56. [in Ukrainian].
Kuharchuk, V. V. (2005). Arterial´naya gipertoniya, narusheniya lipidnogo obmena I ateroskleroz [Arterial hypertension, lipid metabolism disorders and atherosclerosis]. Rukovodstvo po arterial´noj gipertonii. E. I. Chazov, I. E. Chazova (Eds). (pp. 289–299). Moscow: Media Medika. [in Russian].
Lutai, M. I. (2015). Stratifikaciya kardiovaskulyarnogo riska: sovremennye podkhody k opredeleniyu i ocenke [Stratification of cardiovascular risk: modern approaches to identification and evaluation]. Zdorovia Ukrainy, 3, 12–13. [in Russian].
Makarenko, E. S., & Katel´nickaya, L. I. (2007). Fazovyj analiz krovotoka v sonnykh arteriyakh i lipidnyj spektr krovi u bol´nykh AG [Phase analysis of blood flow in the carotid arteries and lipid spectrum of blood in patients with AH]. Ul´trazvukovaya i funkcional´naya diagnostika, 4, 123. [in Russian].
Medvedev, N. V., & Pankova, A. V. (2009). Znachimost´ narushenij lipidnogo obmena v razvitii porazhenij organov-mishenej u bol´nykh arterial´noj gipertoniej pozhilogo vozrasta [Significance of lipid metabolism disorders in the development of lesions of target organs in patients with arterial hypertension of advanced age]. Fundamental´nye issledovaniya, 4, 53–54. [in Russian].
Polyakov, V. Y., Nikolaev, Y. A., Pegova, S. V., Macievskaya, T. R., & Obukhov, I. V. (2015). Osobennosti pokazatelej ul´trazvukovogo dupleksnogo skanirovaniya sosudov shei u bol´nykh arterial´noj gipertenziej s komorbidnoj patologiej [Features indicators ultrasound duplex scanning of neck vessels in hypertensive patients with comorbid pathology]. Mezhdunarodnyj zhurnal prikladnykh i fundamental´nykh issledovanij, 12-1, 88–90. [in Russian].
Petrosov, S. L. (2012). Strukturno-funkcional´nye izmeneniya arterij u muzhchin s arterial´noj gipertoniej i narusheniem zhirovogo obmena v vozrastnom aspekte [Age and arterial structure and function in men with arterial hypertension and lipid metabolism disturbances]. Rossijskiij kardiologicheskij zhurnal, 6(98), 29–33. [in Russian].
Poddubnaya, A. V. (2010). Vliyanie faktorov kardiovaskulyarnogo riska na remodelirovanie levogo zheludochka i variabelnost´ serdechnogo ritma u bol´nykh arterial´noj gipertoniej (Avtoref. dis…kand. med. nauk). [Influence of cardiovascular risk factors on left ventricular remodeling and heart rate variability in patients with arterial hypertension]. (Extended abstract of candidate’s thesis). Ekaterinburg. [in Russian].
Bazina, I. В., Bogachov, R. S., Rafeyenkova, V. S., Kostina, N. I., & Solovyova, N. V. (2007). Harakter dislipidemii, remodelirovanie miokarda i sonnykh arterij u pacientov molodogo vozrasta s e´ssencial´noj arterial´noj gipertoniej [The character of dyslip-idemia and myocardial and carotid arterial remodeling in young patients with essential hypertension]. Klinicheskaya medicina, 85(6), 42–45. [in Russian].
Khurs, E. M., Poddubnaya, A.G., & Evsina, M. G. (2010). Vliyanie dislipidemii na rannyuyu strukturno-geometricheskuyu perestrojku serdca u bol´nykh arterial´noj gipertenziej [Influence of dyslipidemia on early structural and geometric reconstruction of the heart in patients with arterial hypertension]. Arterial´naya gipertenziya, 5, 81–86. [in Russian].
Guo, Z., Hu, X., Wu, M., Zhou, M., & Zhou, Z. (2009). A prospective study on theassociation between dyslipidemia and hypertension. Zhonghua Liu Xing Bing Xue Za Zhi, 30(6), 554–558.
Aaslid, R. (1992). Cerebral hemodynamics. Transcranial Doppler, D. Newell, R. Aaaslid (Eds). New York: Raaven.
Aaslid, R., Markwalder, T., & Nornes, H. (1982). Noninvasive transcranial Dopplerultrasound recording of flow velocity in basal cerebral arteries. Journal of Neurosurgery, 57(6), 769–774. doi: 10.3171/jns.1982.57.6.0769.
Eckel, R., Jakicic, J., Ard, J., de Jesus, J., Houston Miller, N., Hubbard, V., et al. (2014). 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk. Journal of the American College of Cardiology, 63(25), 2960–2984. doi: 0.1016/j.jacc.2013.11.003.
Asmi, M. H., & Walsh, M. J. (1995). A practical guide to echocardiography. London: Chapman& Hall Medical.
Weber, M. A., Schiffrin, E. L., White, W. B., Lindholm, L. H., Kenerson, J. G., Flack, J. M., et al. (2014). Clinical Practice Guidelines forthe Management of Hypertension in the Community. The Journal of Clinical Hypertension, 16(1), 14–26. doi: 10.1111/jch.12237.
Demydenko, G., Kovalyova, O., & Ashcheulova, T. (2015) Types of left ventricular remodeling and features lipid and cytokine profile in patients with essential hypertension. PP.LB02.20. Journal of Hypertension, 33(1), e387.
Laaksonen, D., Niskanen, L., Nyyssonen, K., Lakka, T., Laukkanen, J., & Salonen, J. (2008). Dyslipidaemia as a predictor of hypertension in middle-aged men. European Heart Journal, 29(20), 2561–2568. doi: 10.1093/eurheartj/ehn061.
Sundström, J., Lind, L., Vessby, B., Andren, B., Aro, A., & Lithell, H. (2001). Dyslipidemiaand an Unfavorable Fatty Acid Profile Predict Left Ventricular Hypertrophy 20 YearsLater. Circulation, 103(6), 836–841. doi: 10.1161/01.CIR.103.6.836.
Otsuka, T., Takada, H., Nishiyama, Y., Kodani, E., Saiki, Y., Kato, K., & Kawada, T. (2016). Dyslipidemia and the Risk of Developing Hypertension in a Working‐Age MalePopulation. Journal of the American Heart Association, 5(3), e003053. doi: 10.1161/JAHA.115.003053.
Halperin, R. O., Sesso, H. D., Ma, J., Buring, J. E., Stampfer, M. J., & Gaziano, J. M. (2006). Dyslipidemia and the Risk of Incident Hypertension in Men. Hypertension, 47(1), 45–50. doi: 10.1161/01.HYP.0000196306.42418.0e.
(2017). ESH/ESC Guidelines for the management of arterial hypertension. Hypertens, 31(17), 1281–1357.
O’Brien, E., Parati, G., Stergiou, G., Asmar, R., Beilin, L., Bilo, G., et al. (2013). European Society of Hypertensionposition paper on ambulatory blood pressure monitoring. J Hypertens, 31(9), 1731–1768. doi: 10.1097/HJH.0b013e328363e964.
(2017). Heart rate variability: Standarts of measurement, physiological interpretation, and clinicaluse. Task force of the European Society of cardiology and North American Society of Pacing and Electrophysiology. Circulation, 93, 1043–1065.
Kario, K., Saito, I., Kushiro, T., Teramukai, S., Ishikawa, Y., Mori, Y., et al. (2014). Home blood pressure and cardiovascular outcomes in patientsduring antihypertensive therapy: primary results of HONEST, a large‐scale prospective, real‐world observational study. Hypertension, 64(5), 989–996. doi: 10.1161/HYPERTENSIONAHA.114.04262.
Piccirillo, G., Di Giuseppe, V., Nocco, M., Lionetti, M., MoisÃ, A., Naso, C., et al. (2001). Influence of Aging and Other CardiovascularRisk Factors on Baroreflex Sensitivity. Journal of the American Geriatrics Society, 49(8), 1059–1065. doi: 10.1046/j.1532-5415.2001.49209.x.
Kannel, W. B. (2000). Risk stratification in hypertension: new insights from the Framinghamstudy. American Journal of Hypertension, 13(1), S3–S10. doi: 10.1016/S0895-7061(99)00252-6.
Mathers, C., & Loncar, D. (2006). Projections of Global Mortality and Burden of Diseasefrom 2002 to 2030. PLoS Medicine, 3(11), e442. doi: 10.1371/journal.pmed.0030442.
Son, M., Kim, Y., Lee, D., Roh, H., Son, H., Guk, J., et al. (2014). Pharmacokinetic Interaction Between Rosuvastatin and Telmisartan in Healthy Korean Male Volunteers: A Randomized, Open-label, Two-period, Crossover, Multiple-doseStudy. Clinical Therapeutics, 36(8), 1147–1158. doi: 10.1016/j.clinthera.2014.06.007.
Casino, P., Kilcoyne, C., Quyyumi, A., Hoeg, J., & Panza, J. (1993). The role of nitric oxidein endothelium dependent vasodilation of hypercholesterolemic patients. Circulation, 88(6), 2541–2547. doi: https://doi.org/10.1161/01.CIR.88.6.2541.
Westerhof, N., Lankhaar, J., & Westerhof, B. (2008). The arterial Windkessel. Medical & Biological Engineering & Computing, 47(2), 131–141. doi: 10.1007/s11517-008-0359-2.
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