Features of the pro-inflammatory activation and its role in the pathogenesis of cardiovascular remodeling in hypertensive patients of the ii nd stage
DOI:
https://doi.org/10.14739/2310-1210.2013.4.16826Keywords:
essential hypertension, cardiovascular remodeling, pro-inflammatory activationAbstract
Aim of study: To study the levels of proinflammatory activation markers and establish their importance in the pathogenesis of cardiovascular remodeling in patients with essential hypertension stage II.
Materials and methods.
107 patients with essential hypertension stage II aged 31-73 years (mean age - 53,89 ± 0,88) were included in the study.
Depending on the presence of lesions brachiocephalic arteries patients with hypertension were divided into two groups: the first group consisted of patients with essential hypertension stage II without brachiocephalic arteries pathology, and the second - hypertension stage II with stenotic lesions of brachiocephalic arteries. The control group consisted of 31 healthy individuals.
Ambulatory blood pressure monitoring, determination the thickness of intima-medial complex of the common carotid artery, echocardiography and pulsed - wave Dopplerography, determination of C-reactive protein, α-tumor necrosis factor and sICAM-1 in the serum were conducted for all patients who were included in the study.
Results and discussion.
Daily average, nightly average, and maximum values of systolic and diastolic blood pressure were significantly higher in patients with first and second clinical group compared with those in the control group. In the second group daily level of average systolic blood pressure was higher on 9,8% (p <0,05), average daily diastolic blood pressure on 6,1% (p <0,05), maximum systolic blood pressure on 7,5% (p <0,05) and maximum diastolic blood pressure on 8,7% (p <0,05) were higher than comparable values in the first group. Levels of average daily systolic blood pressure , nightly systolic and diastolic blood pressure in the second group of patients were higher than in the first group on 7,4% (p <0,05), 9,0% (p <0,05), 6,1% (p <0.05), respectively.
Analysis of the variability of blood pressure shows a significant increase of this criterion in patients with hypertension compared with healthy individuals. The frequency values increased variability of systolic and diastolic blood pressure in the second group was 75% and 81% respectively, while in the first group - 60% and 60% respectively.
The patients with hypertension and brachiocephalic stenotic lesions compared with patients of the first group revealed significantly increased frequency of violations diastolic left ventricular function (89% and 75%, respectively), the number of patients with left ventricular hypertrophy ( 84.3% vs. 69.6%), and abnormal left ventricular geometry types (69% and 60% respectively).
Intima-medial thickness of the common carotid artery complex was significantly higher on 84,6% (p <0,05) in the observation group, compared with the control group. The highest values of this index were found in patients with essential hypertension in combination with atherosclerotic lesions, which significantly exceeded similar in 2.31 times (p <0,05) in healthy individuals, as well as 66,7% (p <0,05 ) in patients with essential hypertension.
The patients with essential hypertension have significant elevated levels of serum C-reactive protein in 5.18 times (p <0,05) and increase of tumor necrosis factor-α on 39,04% (p <0,05) compared with control group. It may be noted that the patients with essential hypertension have significant increase of s-ICAM-1 serum level compared to healthy individuals on 41,87% (p <0,05). The serum C-reactive protein, TNF-α and s-ICAM-1 levels in patients with stenotic lesions of brachiocephalic arteries were in 2.35 times (p <0,05), on 33,51% (p <0,05) and on 16 , 05% (p <0,05) higher respectively compared with patients of the first group.
Statistically significant positive correlation relationship between the CRP serum levels and average daily systolic blood pressure (r = 0,61, p <0,05), average daily diastolic blood pressure (r = 0,47, p < 0.05), maximum systolic blood pressure (r = 0,44, p <0,05) and maximum diastolic blood pressure (r = 0,58, p <0,05) were found in our study. Similar correlation relationship was found between the α-TNF serum level and blood pressure parameters - for average daily systolic (r = 0,52, p <0,05), average daily diastolic (r = 0,32, p <0, 05), maximal systolic (r = 0,40, p <0,05) and maximum diastolic blood pressure (r = 0,41, p <0,05) respectively.
Similar correlation relationships were observed between the level of sICAM-1 in serum as a marker of endothelial dysfunction and indicators of daily blood pressure. There were statistically significant positive correlation between the value of sICAM-1 and the level of average systolic blood pressure (r = 0,55, p <0,05), average daily diastolic blood pressure (r = 0,50, p <0 , 05), maximal systolic (r = 0,46, p <0,05) and maximum diastolic blood pressure (r = 0,58, p <0,05).
The strongest relationships were recorded between intima-medial complex as indicator of arterial remodeling processes and proinflammatory activation. For the left ventricular mass index and E/A parameter were also found statistically significant correlation relationships with all indicators proinflammatory activation. However, unlike the process of remodeling of blood vessels, most pronounced relationships registered with the contents of serum s-ICAM-1 and less pronounced from serum α-tumor necrosis factor and C-reactive protein.
So the results of correlation analysis showed that activation of proinflammatory processes may play an important role in the cardiovascular remodeling for hypertensive patients.
Conclusions.
1. The patients with hypertension stage II have activation of proinflammatory processes, which expressed in increasing of serum C-reactive protein, α-tumor necrosis factor and soluble intercellular adhesion molecule-1 compared with the control group, which increasing in the presence of stenotic lesions brachiocephalic arteries.
2. In patients with hypertension and stenotic lesions of brachiocephalic arteries was found more pronounced manifestations of remodeling of blood vessels and heart compared with patients without manifestations of atherosclerosis, resulting in a significant increase in thickness intima-medial complex of the common carotid artery (on 66.7%), significantly increased frequency of violations left ventricular diastolic function (by 18.7%), detection of left ventricular hypertrophy (on 21.1%), and abnormal left ventricular geometry types (on 12.1%).
3. In patients with essential hypertension dominated abnormal types of diurnal blood pressure profiles, which manifested an increasing number identifying types of "non-dipper" and "night-peaker". Levels of systolic and diastolic average blood pressure have highest positive correlation with indicators of proinflammatory activation.
4. Increased proinflammatory activity is an important factor in the development of cardiovascular remodeling in patients with essential hypertension stage II, as evidenced by the close relationship between indicators of proinflammatory activation and the processes of structural and functional reorganization of the heart and arterial vessels.
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