The impact of obesity on the parameters of cardiovascular remodeling, cerebral blood flow and autonomic regulation of cardiac rhythm in hypertensive patients
DOI:
https://doi.org/10.14739/2310-1210.2017.2.95554Keywords:
hypertension, arterial blood pressure, obesity, cardiovascular remodeling, vegetative balanceAbstract
Objective. The aim of this study was to assess autonomic regulation disturbances, disorders of systemic, brain and intra-cardiac hemodynamics and to find out the features of vascular and cardiac remodeling in patients with arterial hypertension associated with obesity.
Materials and Methods. The study involved 82 patients with stage II hypertension combined with obesity (39 men and 43 women) and 18 (12 men and 6 women) patients with essential hypertension with normal body weight. All the patients underwent general clinical examination, ECG Holter monitoring with heart rate variability analysis, 24h ABPM, duplex echocardiography and pulsed-wave Doppler of extracranial vessels.
Results. Patients with essential hypertension associated with obesity have significantly higher average daily SBP by 9.4% (p = 0.036), average DBP by 12.1% (p = 0.027) and hypertension time index by 83.3% (p = 0.012), diastolic size of LA by 11.1% (p = 0.007), IVSTd by 23.7% (p = 0.001), LVMI by 14.3% (p = 0.022) and reduced volume-mass index of LV by 18.8% (p = 0.013). In patients with essential hypertension with obesity we observed a significant decrease in Vmax in the left CCA by 16.5% (p = 0.003) and in the right CCA by 12.6% (p = 0.046), Vmean in the left CCA by 16.8% (p = 0.001) and in the right CCA by 14.4% (p = 0.009), reduced Vmax by 19.1% (p = 0.002) and Vmean by 21.9% (p = 0.002) in the right ICA. Levels of Vmax and Vmean in the left MCA in hypertensive patients with obesity were lower by 10.2% (p = 0.043) and 12.5% (p = 0.044), while the index of vascular reactivity sensitive to hypercapnia in the left MCA was lower by 14.6% (p = 0.015). In overweighed patients with hypertension the linear Vmax in the left VA was lower by 13.9% (p = 0.015) and Vmean 14.5% (p = 0.013), in the right VA Vmax and Vmean were lower by 17.7% (p = 0.011) and 25.8% (p = 0.003). In group with hypertension and obesity Vmean in BA showed a reduction by 17.3% (p = 0.021), and index of reactivity sensitive to hypercapnia by 23.1% (p = 0.002). Hypertensive patients with obesity and with normal body weight did not differ by temporal and spectral parameters of HRV. Index LF/HF in both groups exceeded 2 cu.
Conclusions. The presence of obesity in patients with essential hypertension is accompanied by significantly higher average SBP and DBP, daily hypertension time index according to 24h ABPM, a significant increase in diastolic LA size, IVSTd, LVMI and decrease of LV volume-mass index, decreased blood flow in CCA, right ICA, left MCA, both VA and BA, index of vascular reactivity sensitive to hypercapnia in the left MCA and BA. In patients with essential hypertension regardless of whether obese or of normal body weight sympathetic part of the autonomic nervous system prevails.
References
Andrieieva, A. O., Shkolnik, V. V., & Yarmish, N. V. (2014) Vzaimosvyaz' remodelirovaniya sosudov i markerov immunnogo vospaleniya u pacientov s gipertonicheskoj bolezn'yu na fone abdominal'nogo ozhireniya [The relationship of vascular remodeling and markers of immune inflammation in patients with essential hypertension combined with abdominal obesity]. Nauchnye vedomosti Belgorodskogo gosudarstvennogo universiteta. Seriya: Medicina. Farmaciya, 4(25), 35–40. [in Russian].
Dorohoi, A. (2011). Termіn vykonannia «Programy profіlaktyky і lіkuvannia arterіal'noi gіpertenzіi v Ukrainі» zakіnchyvsija, problemy zalyshyilysia. Shcho dalі? [Deadline "Programme of prevention and treatment of hypertension in Ukraine" is over, the problem remained. What's next?]. Arterial'naya gipertenziya, 3(17), 29–56. [in Ukrainian].
Kovalenko, V. N. & Lutai, M. I. (2012). Analiz e´ffektivnosti ambulatornogo lecheniya bol'nykh IBS v sochentanii s arterial'noj gipertenziej v Ukraine [Treatment effectiveness analysis of outpatients with arterial hypertension plus coronary heart disease in Ukraine]. Evrazijskij kardiologicheskij zhurnal, 2, 17–29. [in Russian].
Lutaj, M. I. (2015). Stratifikaciya kardiovaskulyarnogo riska: sovremennye podkhody k opredeleniyu i ocenke [Stratification of cardiovascular risk: current approaches to defining and evaluating]. Zdorovia Ukrainy, 3, 12–13. [in Ukrainian].
Paulava, V. S. (2012). Sovremennye vozmozhnosti e´ffektivnoj serdechno-sosudistoj profilaktiki u pacientov s arterial'noj gipertenziej i dislipidemiej [Actual possibilities of effective cardiovascular prevention in patients with arterial hypertension and dyslipidaemia]. Medicinskie novosti, 1, 62–68. [in Belarus].
Vasilkova, T. N., Baklaeva, T. B., Mataev, S. I., & Rybina, Yu. A. (2013). Rol' ozhireniya v formirovanii serdechno- sosudistoj patologii [Significance of obesity in cardiovascular pathology]. Prakticheskaja medicina, 7(76), 117–122. [in Russian].
Suhonos, V. A. (2013). Strukturno-funcional'noe sostoyanie magistral'nykh sosudov i pokazatelej kliniko-laboratornogo statusa u bol'nykh gipertonicheskoj bolezn'yu s razlichnoj massoj tela [Structural and functional state of the trunk vessels and indicators of clinical and laboratory status in hypertensive patients with different body mass]. Zhurnal klinichnykh ta eksperymentalnykh medychnykh doslidzhen, 1(2), 209–213. [in Ukrainian].
Radchenko, G. D., Slashcheva, T. G., Sirenko, Yu. M., & Mushtenko, L. O. (2015). Chynnyky, yaki vplyvaiut na kontrol arterialnoho tysku u khvorykh na arterialnu hipertenziiu zalezhno vid viku [Factors influencing blood pressure control in hypertensive patients depending on age]. Ukrainskyi kardiolohichnyi zhurnal, 5, 19–30. [in Ukrainian].
Lim S, S., Vos, T., Flaxman, A., Danaei, G., Shibuya, K., Adair-Rohani, H., et al. (2012). A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 380(9859), 2224–2260. doi: 10.1016/S0140-6736(12)61766-8.
Aaslid, R. (1992). Cerebral hemodynamics. Transcranial Doppler. D.W. Newell, R. Aaaslid (Eds.). New York: Raven Press.
Aaslid, R., Markwalder, T., & Nornes, H. (1982). Non-invasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. Journal of Neurosurgery, 57(6), 769–774. doi: 10.3171/jns.1982.57.6.0769.
Despres, J., Lemieux, I., Bergeron, J., Pibarot, P., Mathieu, P., Larose, E., et al. (2008). Abdominal Obesity and the Metabolic Syndrome: Contribution to Global Cardiometabolic Risk. Arteriosclerosis, Thrombosis, and Vascular Biology, 28(6), 1039–1049. doi: 10.1161/ATVBAHA.107.159228.
Eckel, R. H., Jakicic, J. M., Ard, J. D., de Jesus, J. M., Houston Miller, N., Hubbard, V. S., et al. (2014). 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 63(25), 2960–2984. doi: 10.1016/j.jacc.2013.11.003.
Alexander, J. (1965). Chronic heart disease due to obesity. Journal of Chronic Diseases, 18(9), 895–898.
Alpert, M., Omran, J., & Bostick, B. (2016). Effects of Obesity on Cardiovascular Hemodynamics, Cardiac Morphology, and Ventricular Function. Current Obesity Reports, 5(4), 424–434. doi: 10.1007/s13679-016-0235-6.
Asmi, M., & Walsh, M. (1995). A practical guide to echocardiography. London: Chapman & Hall Medical.
Flegal, K. M., Kit, B. K., Orpana, H., & Graubard, B. I.2013). Association of All-Cause Mortality With Overweight and Obesity Using Standard Body Mass Index Categories. JAMA, 309(1), 71–82. doi: 10.1001/jama.2012.113905.
Gricaenko, G. A., Khusainova, L. N., Belyaeva, I. G., & Mingazetdinova, L. N. (2010). Cardiorenal the syndrome as predictor remodeling of vessels at sick of the arterial hypertonia. Modern problems of science and education, 3, 37–43.
DeMarco, V., Aroor, A., & Sowers, J. (2014). The pathophysiology of hypertension in patients with obesity. Nature Reviews Endocrinology, 10(6), 364–376. doi:10.1038/nrendo.2014.44.
Yusuf, S., Hawken, S., Ôunpuu, S., Dans, T., Avezum, A., Lanas, F., et al. (2004). Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. The Lancet, 364(9438), 937–952. doi: 10.1016/S0140-6736(04)17018-9.
Mancia, G., Fagard, R., Narkiewicz, K., Redón, J., Zanchetti, A., Böhm, M., et al. (2013). 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J. Hypertens, 31(7), 1281–1357. doi: 10.1097/01.hjh.0000431740.32696.cc.
O'Brien, E., Parati, G., Stergiou, G., Asmar, R., Beilin, L., Bilo, G., et al. (2013) European Society of Hypertension position paper on ambulatory blood pressure monitoring.. J. Hypertens, 31(9), 1731–1768. doi: 10.1097/HJH.0b013e328363e964.
(1996). Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation, 93, 1043–1065. doi: https://doi.org/10.1161/01.CIR.93.5.1043.
Neter, J. E., Stam, B. E., Kok, F. J., Grobbee, D. E., & Geleijnse, J. M. (2003). Influence of Weight Reduction on Blood Pressure: A Meta-Analysis of Randomized Controlled Trials. Hypertension, 42(5), 878–884. doi: 10.1161/01.HYP.0000094221.86888.AE.
Must, A., Dallal, G., & Dietz, W. (1991). Reference data for obesity: 85th and 95th percentiles of body mass index (wt/ht2) and triceps skinfold thickness. Am. J. Clin. Nutr, 53(4), 839–846.
Ahmad, S., & Imam, S. (Eds.) (2016). Obesity: A Practical Guide. Springer International Publishing.
(1998). Obesity: Preventing and Managing the Global Epidemic: Report of a WHO Consultation on Obesity. Geneva.
O'Donnell, M., Xavier, D., Liu, L., Zhang, H., Chin, S. L., Rao-Melacini, P., et al. (2010). Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet, 376(9735), 112–123. doi: 10.1016/S0140-6736(10)60834-3.
Turkbey, E., McClelland, R., Kronmal, R., Burke, G. L., Bild, D. E., Tracy, R. P., et al. (2010). The impact of obesity on the left ventricle: the Multi-Ethnic Study of Atherosclerosis (MESA). J. Am. Coll. Cardiol. Img., 3, 266–274. doi: 10.1016/j.jcmg.2009.10.012.
Hussey, J., Nguyen, Q., Whitsel, E., Richardson, L., Halpern, C., Gordon-Larsen, et al. (2015). The reliability of in-home measures of height and weight in large cohort studies. Demographic Research, 32(1), 1081–1098. doi: 10.4054/DemRes.2015.32.39.
Di Cesare, M., Bentham, J., Stevens, G., Zhou, B., Danaei, G., Lu, Y. et al. (2016). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19•2 million participants. The Lancet, 387(10026), 1377–1396. doi: 10.1016/S0140-6736(16)30054-X.
Romero, R., Bonet, J., de la Sierra, A., & Aguilera, M. T. (2007). Undiagnosed obesity in hypertension: Clinical and therapeutic implications. Blood Pressure, 16(6), 347–353. doi: 10.1080/08037050701715117.
Vaidean, G., Manczuk, M., & Magnani, J. (2016). Atrial electrocardiography in obesity and hypertension: Clinical insights from the Polish-Norwegian Study (PONS). Obesity, 24(12), 2608–2614. doi: 10.1002/oby.21678.
Weber, M. (2014). The Evolving Clinical Management of Hypertension. The Journal of Clinical Hypertension, 16(12), 917–924. doi: 10.1111/jch.12444.
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