Diagnostic importance of ambulatory blood pressure monitoring rates for arterial stiffness estimation among patients with arterial hypertension

Dissertation abstract
Nosov A.E.
GOU VPO “Roszdrav’s Perm State Medicine Academy after E.A.Wagner”
Scientific adviser: Doctor of Medicine, A.V. Agafonof
Scientific consultant: Honoured worker of science, Doctor of Medicine, Professor A.V.Tuev

Purpose: Study importance of ambulatory blood pressure monitoring rates for arterial stiffness estimation among patients with arterial hypertension, specify their relations to indices of structural functional myocard remodeling, blood plasma lipidic spectrum, hemostasis system.
Research purposes:

1. Study daily arterial stiffness and its dynamics with the use of APM oscillometric method among old age arterial hypertension patients.
2. Study rates of daily APM and their relationship with arterial stiffness rates in the above-mentioned group.
3. Evaluate effects of age on heart condition, hemostasis system.
4. Study daily artery stiffness and its dynamics with the use of APM oscillometric method at ISAH in comparison with SDG, and also BP daily profile features, possible interrelations between stiffness rates and heart condition, hemostasis system.
5. Evaluate interrelation between cardiovascular risk and daily BP monitoring rates (including arterial stiffness) for arterial hypertension patients. 

Materials and methods: Patients to be observed were taken from cardiological clinic at Perm periphery clinical hospital. 77 patients were examined, 57 (74%) among them were diagnosed arterial hypertension, and 20 had normal blood pressure and didn’t suffer from hypertensive illness according to case history. Patients of this group had situational blood pressure increase in case history but this diagnosis wasn’t confirmed during blood pressure monitoring later on.  Among the examined ones there were 52% male, 48% female. The average age of the examined patients was 51,9 ± 12,8 years with age variance from 23 to 83 years. 60-year patients and older were considered to be aged people. Share of such patients amounted 29%.
Criteria for inspection inclusion: blood pressure availability or blood pressure suspicion.
Criteria for exclusion: cardiac failures, symptomatic blood pressure, occlusive peripheral atherosclerosis, thyroid function abnormalities, cardiac rhythm disturbance during inspection, acute infectious diseases, chronic lung diseases in case history, renal and hepatic insufficiency, acute myocardial infarction, instable angina, acute cerebrovascular accident, heart rhythm break, anaemia, cardiac failure IV FC according to NYHA, rheumatic diseases, retinopathy III-IV degree, orthostatic hypotension, conditions demanding hormonal and steroid therapy or anticoagulant prescription, oncological diseases or other pathologies that may have effect on peripheral arteries condition.
Blood pressure patients diagnostic structure looked as follows: 1 degree – 5%, 2 degree – 38%, 3 degree – 57%; 1 stage – 9%, 2 stage – 63%, 3 stage – 28%.  Share of low overall risk of infarctions, insults and lethal cardiovascular complications was 0%, medium – 19%, high – 21% and very high – 60%.
28% patients with arterial hypertension had such associated diseases (3d stage of hypertensive disease) as stable angina, II functional class. Exertional angina was diagnosed as per medical data.
The patients included into inspection were sequentially divided in two groups two times: on age principle (60 years plus – aged – and under 60 years) and ISAH availability principle.
At analysis of mentioned groups’ homogeneity it is determined that blood pressure doesn’t differ in groups of patients under 60 years and older 60 years: daily average systolic blood pressure amounted 129,3 ± 14,7 mmHg and 136,5 ± 18,9 mmHg accordingly (p=0,1), daily average diastolic blood pressure 81,9 ± 11,5 mmHg and 81,0 ± 10,3 mmHg accordingly (p=0,9).
In the group of patients under 60 years there were 56% male, 44% - female; in the group of patients 60 years plus – 41% and 59% accordingly. Sex composition didn’t differ much in the groups of patients under or older 60 years. (p=0,22).
11 patients belonged to subgroup ISAH, there were 58% female among them. The average age was 54,2 ± 11,6 years what doesn’t differ from average age of patients with SDG statistically – 53,4 ± 9,9 years (p=0,2). 46 patients belonged to SDG subgroup, among them there were 33% female, 67% male. Sex composition didn’t differ significantly in ISAH and SDG groups.
Daily systolic blood pressure didn’t differ in ISAH and SDG groups: 131,2 ± 8,6 mmHg and 137,5 ± 17,0 mmHg accordingly (p=0,29). Daily diastolic pressure in ISAG subgroup was significantly lower than in SDG subgroup – 74,5 ± 4,8 mmHg and 87,4 ± 10,9 mmHg accordingly (p=0,0001).
Program of patients examination included overall clinical (case history study, physical examination) and additional methods: haemogram, lipidogram, coagulogram were analyzed; echocardiography and ambulatory blood pressure monitoring by oscillometric method were carried out.