Circadian rhythms and seasonally dependent variability of arterial pressure in patients with arterial hypertension in the Khanty-Mansiysky region

Key parameters of 24-h blood pressure monitoring (BPM) in 46 18-50-year-old patients (men and women) with arterial hypertension (AH) stage I, II and 33 healthy persons living in the Tyumen North (Khanty-Mansiysky Region, the town of Nyagan) were investigated. The comparison group consisted of 55 patients with AH stage I, II and 33 healthy persons living in moderate climate (Tyumen) matched by sex, age, duration of AH, office systolic and diastolic arterial pressure (SAP, DAP). General patterns of 24-h and seasonal rhythms of AP fluctuations in healthy northerners and citizens of moderate climatic zone and mismatch of these rhythms in AH patients more evident in the northerners are shown. Paired correlations were obtained which indirectly confirm the priority role of daily AP rhythm in development of visceral lesions irrespective of the season of the year and climatic load. In the North, when winter meets spring, a surge of SAP, DAP and mean AP occurs as well as an increase in heart rate, number of patients with disturbed circadian profile of AP. In moderate climate these changes are more typical for summer period. The results of the study necessitate design of programs of additional pharmacological and preventive measures for hypertensive northerners with consideration of AP seasonal rhythms and climatic load.     

24-h profile of arterial pressure in hypertensive patients working in rotatory teams in conditions of Far North (Tyumen Region)

AIM: To specify a 24-h profile of arterial pressure (AP) in hypertensive patients working in duty regime in the Far North (Tyumen Region). MATERIAL AND METHODS: AP parameters were studied in 155 males aged 25-59 with hypertension of stage I, II who were employed for duty work in the Far North areas and 38 control patients with hypertension stage I, II living in a moderate climatic zone (Tyumen). The groups were comparable by gender, age, duration of hypertension, office systolic and diastolic AP (SAP and DAP). All the patients have undergone 24-h monitoring of AP with assessment of basic mean parameters. RESULTS: The study group patients had scare symptoms and lower mean 24-h SAP, but high AP variability, high DAD as reflection of more significant structural changes of vessels and special functioning of the autonomic nervous system in the North. Mean 24-h AP showed more unfavourable changes in hypertensive subjects who had flight from Yamburg-Moscow-Yamburg. CONCLUSION: The data of the study dictate the necessity to develop a differentiated risk strategy for health promotion, prevention and treatment of hypertension in those who work in the North of Tyumen Region in duty regime.     

Development and course of arterial hypertension based on 24-hour monitoring of arterial pressure in a population of the Tyumen region

Arterial pressure (AP) was monitored in 46 patients with arterial hypertension (AH) aged 18-50 years and in 33 healthy subjects living in Russian North (Tyumen Ob area, Nyagan). The comparison group consisted of 55 patients with AH and 33 healthy subjects living in a moderate climatic zone (Tyumen). The groups were comparable by gender, age, duration of AH, office systolic and diastolic AP (SAP and DAP). Healthy subjects of Tyumen North compared to those living in the moderate climate had more pronounced vegetative imbalance which may transform into AH. The North AH is characterized by high meteorability, impaired circadian AH profile with reduction of the SAP fall day-night and an increase of the DAP fall, greater variability of AP, elevated AP day load, low night DAP. This classifies AH in the northerners as isolated systolic. While AH development in the North takes place due to marked AP fluctuations, in moderate climate it follows a classic variant--due to a DAP rise. The above changes may help prognosis of emergence of cardiovascular complications in hypertensive patients living in the North.     

Characteristics of circadian rhythms of arterial pressure and heart rate in hypertensive subjects living in the North of the Tiumen' region

Chronostructure of arterial pressure (AP) and heart rate (HR) was studied in 62 residents of Tumen Region North with arterial hypertension (AH) aged 18-50 years and 56 AH controls living in the temperate zone. The groups were matched by age, sex, AH duration, office systolic and diastolic arterial pressure (SAP and DAP, respectively). Circadian AP profile with night hypertension was registered in 76.6 and 28.3% patients of the test and control groups, respectively. Test group patients had more pronounced defects in DAP and HR chronostructures. Thus, AH patients living in the Tumen North demonstrate abnormal circadian AP profile and AP and HR chronostructure. This may be prognostically important for development of cardiovascular complications.     

The relationship between the 24 hour arterial pressure profile with heart changes in patients with essential hypertension

A 24-h profile of arterial pressure (AP), structural-geometrical changes of the left ventricle (LV) and severity of hypertensive heart were compared in 47 patients with essential hypertension. Absolute AP and LV geometric models were not related. In patients with concentric LV hypertrophy, the time index (TI) of night systolic hypertension was significantly higher than TI in excentric LV hypertrophy. A relationship was found between mean day systolic pressure, a morning rise in AP and form of LV hypertrophy. The severity of hypertensive heart correlated with TI of 24-h systolic arterial pressure (SAP), TI of 24-h diastolic arterial pressure (DAP), mean 24-h SAP, mean daytime SAP, mean night SAP, mean 24-h DAP, mean daytime DAP, a morning rise in DAP. Thus, a 24-h AP profile, a morning rise in DAP, 24-h hypertension time correlate with LV structural-geometric changes and severity of hypertensive heart.     

Effects of ACE inhibitor fosinopril on a 24-h profile of arterial pressure in hypertensive patients with obesity and hypercholesterolemia

AIM: To study effects of fosinopril on a 24-h profile of blood pressure (BP) in hypertensive patients with obesity and hypercholesterolemia. MATERIAL AND METHODS: A randomized comparative trial enrolled 96 patients aged 30-50 years with arterial hypertension (AH) of the first and second degree. The patients were randomized into 2 groups by age, gender, AH duration, office AP, body mass index, cholesterol level. The patients of group 1 received fosinopril (monopril) in a single daily dose 10 mg with further rise to 20 mg. The patients of group 2 were given metoprolol twice a day in a dose 25 mg with further rise to 75 mg. Examination of the patients was made before the treatment and after 16 weeks of therapy with fosinopril and metoprolol. RESULTS: A 16-week therapy with fosinopril resulted in lowering of office BP, mean day systolic, diastolic, pulse BP. The profile of SBP improved: the number of "dippers" with an adequate day profile of BP rose. Fosinopril significantly reduced left ventricular myocardial mass (LVMM) and myocardial mass index. Metoprolol had the same hypotensive action but had no effect on mean 24-h pulse and mean BP, LVMM, LVMM index. CONCLUSION: Fosinopril is more effective than metoprolol in relation to a 24-h profile of BP and LVMM reduction.     

The rhythms of arterial pressure and heart rate in individuals with arterial hypertension under the conditions of Far North

The circadian and ultradian rhythms of blood pressure (BP) and heart rate (HR) were studied by means of 24-hour BP monitoring in patients with arterial hypertension (AH) and practically healthy people working in Far North shifts. The subjects were 418 men. The main group consisted of 177 men aged 18 to 59 working in trans-polar shifts in Yamburg, Tyumen region, latitude 57 North. The comparison group included 158 residents of a moderate climatic zone (Tyumen, latitude 57 North). The control group consisted of 83 practically healthy men, of whom 43 worked in Far North shifts, and 40 were residents of Tyumen. The groups were comparable by age, AH duration, and office systolic and diastolic BP (SBP; DBP). The study demonstrates that even healthy people working in Far North shifts display high BP variability and the decrease of the stability and power of SBP, DBP and HR circadian rhythms due to the reduction of the amplitude, contribution of the rhythm to the total variability, and the increase of the amplitude of high-frequency harmonics of the spectrum (a manifestation of extracircadian dissemination), which may be a sign of accelerated ageing and biological age increase, and may facilitate AH development. Development of AH under the extreme conditions of Far North shifts, unlike the conditions of moderate climatic zones, is accompanied by progressive BH variability increase, the worsening of the chronological structure of SBP and DBP, the increase of extracircadian dissemination, which can be of both clinical and prognostic significance.     

Significance of pharmacological blockade of angiotensin II type I receptors for correction of abnormal 24-hour blood pressure profile depending on its variability in patients with arterial hypertension stage II

AIM: To specify variable 24-h arterial hypertension (AH) stage II profile and to assess significance of pharmacological block of the end of the renin-angiotensin-aldosteron system for correction of the determined disorders. MATERIAL AND METHODS: The study was made of 46 men (mean age 42.8 +/- 3.28 years) with stage II AH and 25 normotensive controls (mean age 39.2 +/- 3.10 years). Depending on the magnitude of mean 24-h AP variability (APV), hypertensive patients were divided into two groups. Variability of systolic and/or diastolic AP (SAPV and DAPV, respectively) was considered high in at least 15.2 and/or 12.3 mm Hg variability, respectively, and normal at less values. RESULTS: AP 24-h profile in men with AH stage II and high APV compared to patients with normal APV is characterized by higher frequency of AP rise and less frequency of its night fall. In patients with high APV the drug eprosartan (teveten) is more effective in correction of hypertension and night fall of AP. CONCLUSION: Eprosartan has an adequate corrective activity in relation to absolute values of SAP and DAP in different hours. The highest hypotensive activity of the drug was seen in persons with initially high circadian AP variability within 24 hours.     

Dynamics of a 24-h profile of arterial pressure and function of the vascular endothelium in nebivolol treatment of hypertensive patients

To assess a hypotensive activity of nebivolol (nebilet) including its action on the 24-h profile and baroreceptor control of arterial pressure (AP), vegetative regulation of the heart and vasculomotor endothelial function in AP patients, 30 AH patients were given nebivolol in a dose 5 mg/day for 8 weeks. The results of the treatment show that nebivolol effectively maintains a safe 24-h control of AP, acts positively on chronostructure of AP 24-h profile, produced no clinically significant side effects, corrects vegetative heart regulation and improves baroreceptor AP control. Moreover, nebilet modulates a stable vasodilating effect which improves function of vascular endothelium, initiates regression of left ventricular myocardium hypertrophy by raising its elasticity without changing much its contractile function. Thus, nebivolol is a highly effective drug for treatment of arterial hypertension which corrects a wide spectrum of unfavourable shifts in cardiovascular system function.     

Thiaside diuretics in combination with inhibitors of angiotensin-converting enzyme in patients with diabetes mellitus type 2 comorbid with arterial hypertension

AIM: To study the effect of co-renitek monotherapy for 16 weeks on parameters of 24-h monitoring of arterial pressure, carbohydrate, lipid, purin metabolism in patients with mild and moderate arterial hypertension (AH) and diabetes mellitus (DM) type 2. MATERIAL AND METHODS: 20 patients with DM type 2, mild or moderate AH received co-renitek (1-2 tablets a day) for 16 weeks. Before the treatment and 16 weeks later the patients were examined (24-h AH monitoring, carbohydrate, lipid, purin, electrolyte metabolism). RESULTS: Co-renitek treatment of DM type 2 patients with hypertension led to a significant lowering of mean systolic and diastolic pressure, improvement of 24-h AP profile and reduction of fasting glucose level. Co-renitek proved to be metabolically neutral in relation to lipid, purin and electrolyte metabolism. CONCLUSION: Co-renitek is effective and safe antihypertensive drug for treatment of arterial hypertension in patients with diabetes mellitus type 2.     

Characteristics of hypotensive effect in patients with arterial hypertension and desaturation signs of obstructive sleep apnea syndrome during sleep

AIM: To estimate the efficacy of 8-week antihypertensive monotherapy in patients with arterial hypertension (AH) regarding the presence of obstructive sleep apnea syndrome (OSAS). MATERIAL AND METHODS: We analysed the results of 24-h blood pressure (BP) monitoring of 26 inpatients (mean age 54 +/- 2 years) with mild (n = 18) and moderate (n = 8) AH before and after 8 weeks of treatment with 5-10 mg amlodipine or 50-100 mg of losartan once daily to assess blood pressure profile parameters. The patients underwent nocturnal monitoring of arterial oxygen saturation (pulsoximeter NONIN-8500 M, USA). The presence of OSAS was confirmed when a characteristic clinical picture was combined with the presence of significant (> 4%) sleep desaturation episodes > 15 episodes per hour or the presence of group desaturation episodes below 90%. Seven hypertensive patients with OSAS were assigned to group 1, nineteen patients without OSAS--to group 2. The differences in estimated parameters between the groups were tested by Mann-Whitney U test, the dynamics of BP profile parameters--by Wilcoxon matched pairs test. RESULTS: In group 1 there were no significant differences by most of BP profile parameters before and after antihypertensive treatment, except mean nocturnal systolic BP. In group 2 a significant hypotensive effect was seen by all parameters of BP profile except BP variability. Hypotensive efficacy in group 2 was 1.5-2 times higher vs group 1, but the difficulties were not significant. CONCLUSION: Antihypertensive therapy in hypertensive patients with OSAS is less effective than in those without OSAS but it is not uneffective.     

Left ventricular diastolic function in subjects with arterial hypertension living in the Far North depending on the work schedule

Left ventricular diastolic function (LVDF) was studied in subjects with arterial hypertension (AH) living in the Far North in relation to their working regime. A total of 95 patients with grade I-II AH were divided into two groups, one including 53 dayworkers the other comprising 42 patients working in shifts. The control group included 25 practically healthy subjects. All the patients were examined by Doppler echocardiography. Analysis of the results demonstrated that patients with AH working night shifts more frequently experienced LVDF disturbances than subjects of other groups. These disturbances included increased contribution of the left atrial systole to left ventricle filling. Patients with AH exhibited the well-apparent dependence of left ventricle diastolic filling on the degree of its hypertrophy. LVDF was related to the elevation of nocturnal arterial pressure due to a rise in systolic AP.     

24-Hour arterial pressure profile in chronic obstructive lung diseases in combination with arterial hypertension treated with enalapril

AIM: To evaluate peculiarities and trends in 24-hour arterial pressure (AP) profile and bronchoobstructive syndrome (BOS) in patients with chronic obstructive pulmonary diseases (COPD) and arterial hypertension (AH) on combined treatment including enalapril maleate. MATERIAL AND METHODS: Changes in BOS as shown by clinical data, data of peakflowmetry and external respiration function as well as in AP 24-hour profile according to 24-hour monitoring were studied in 50 patients with exacerbation of bronchial asthma and chronic bronchitis treated for 4 weeks with conventional broncholytic and antiinflammatory modalities, in 28 patients with mild and moderate AH receiving combined therapy including enalapril maleate. RESULTS: In exacerbation of COPD, 24-h AP profile is characterized by high frequency of the curve "non-dipper". Concomitant mild and moderate AH was diagnosed in more than half of the examinees. The addition of enalaprile maleate to the treatment in many cases lowered systolic and diastolic AP, normalized sympathicoadrenal system and 24-hour AP rhythm, reduced dyspnea, improved exercise tolerance, sleep. Good tolerance of the drug was seen in patients with exacerbation of COPD. CONCLUSION: In exacerbation of COPD it is recommended to monitor AP for 24 hours for early detection of AH and initiation of combined treatment with correction of bronchoobstructive syndrome and hemodynamic disorders. As a hypotensive drug, enalapril maleate is adequate in such patients.     

Intrarenal hemodynamics and blood pressure in hypertensive patients with renal artery anomalies

AIM: To determine characteristics of a clinical course, 24-h profile of arterial pressure (AP), of renal hemodynamics, involvement of target organs in patients with arterial hypertension (AH) of the third degree and anomalies of renal arteries. MATERIAL AND METHODS: 24-h monitoring of AP, echocardiography, measurement of microalbuminuria, renal hemodynamic were made in 15 patients (9 female, 6 male) having resistant AH of the third degree and different anomalies of renal arteries (mean age 45.3 +/- 1.9 years). The control group consisted of patients with essential AH stage III (mean age 45.3 +/- 1.8 years). The groups were comparable by sex, age, duration of AH. RESULTS: The patients of the study group had a significantly lower pulsatility index in the renal artery and interlobular level and resistance index at the segmental and interlobular level of the RA on the side of the anomaly. There was a significantly higher minimal diastolic blood flow velocity in the segmental level of RA on the side of the anomaly. Renal scintigraphy revealed a decreased index of radiopharmaceutical accumulation. A positive correlation was found between the pulsatility index, resistance at a segment RA level and variability, an increase of morning diastolic blood pressure. The groups had significant differences neither by 24-h AP indices nor by severity of target organ lesion. CONCLUSION: Patients with RA anomalies have specific renal hemodynamics determining renal hypoperfusion on the side of the anomaly which may be involved in development of resistance to hypotensive therapy.     

Twenty-four-hour profile of arterial pressure in patients with hypothyroidism

The purpose of the investigation was to study the effects of hypothyroidism on the 24-hour profile of arterial pressure (AP). One hundred and fifty-one patients (mean age 52 +/- 3.2 years) with primary hypothyroidism and concomitant arterial hypertension were examined; the patients received substitutive therapy (levothyroxine sodium) and standard hypotensive therapy (ACE inhibitors and indapamide). Twenty-four-hour AP monitoring was performed; the level of thyrotropic hormone was measured by immune enzyme assay. The patients were distributed into two groups according their thyroid status. Group 1 consisted of 72 patients with compensated hypothyroidism; 79 patients with decompensated hypothyroidism constituted group 2. The study found the following facts about patients with decompensated hypothyroidism: higher systolic AP, high variability of nocturnal AP, insufficient decrease in AP during day hours, and accelerated morning AP increase. The results suggest that hypothyroidism has significant effects on the 24-hour AP profile, and its decompensation lowers the efficacy of hypotensive therapy.     

Clinical, metabolic, age-related, and biorhythmologic aspects of daily arterial pressure profiles in patients with arterial hypertension

The work was designed to study daily arterial pressure (AP) profile in 103 patients aged 20-70 (48.6 +/- 12.) years with grade I-II arterial hypertension and its relation to selected metabolic parameters, heliogeophysical factors and age. The patients underwent 24-hr AP monitoring, calculation of body mass index, measurement of blood glucose and cholesterol levels. Non-dippers showed higher mean nocturnal AP values than dippers probably due to higher BMI, glucose and cholesterol levels. These patients were more sensitive to heliophysical factors. Patients above 60 years displayed higher AP values in morning hours compared with 21-40 year-old ones. These data can be used in the development of primary and secondary prophylaxis of arterial hypertension.     

Correction of sleep disorders and efficacy of antihypertensive monotherapy in elderly patients: use of ivadal]

AIM: To assess effects of ivadal (zolpidem) on arterial pressure (AP) in the cycle sleep-awake in aged patients with insomnia who have failed hypotensive monotherapy with different drugs, i.e. whose AP remained abnormal at night. MATERIALS AND METHODS: The trial included 25 aged patients (17 females, 8 males, mean age 66.4 +/- 3.7 years) with isolated systolic arterial hypertension (AH) of the first-second degree (WHO classification, 1999) and insomnia. AH duration averaged 8.7 +/- 3.7 years. All the patients have received antihypertensive monotherapy. As shown by the initial 24-h monitoring, patients with elevated night AP had significantly lower mean score by the questionnaire "Subjective Sleep Characteristics" and more frequently suffer from insomnia. These patients were given a hypnotic drug ivadal (zolpidem) in a single daily dose 5 mg in the evening for 10 days. On the treatment night 10 monitoring of AP was repeated. RESULTS: Ivadal treatment has significantly improved all the subjective parameters of sleep and 24-h AP profile, lowered sleep and awake AP. CONCLUSION: Ivadal treatment raises efficacy of a hypotensive monotherapy in aged patients with isolated systolic AH and insomnia.     

The response to normobaric hypoxia and its duration in arterial hypertension patients as shown by a prospective study

A placebo-controlled parallel trial studied an antihypertensive action of interrupted normobaric hypoxia (INH) in 63 male patients with arterial hypertension (AH) of the first degree and low and moderate risk of vascular complications. The placebo group consisted of 18 patients with AH of the first degree matched by age, the disease duration, initial level of systolic and diastolic pressure. An INH course consisted of 15 daily procedures. INH monotherapy implied oxygen content lowering to 10%. A 6-month follow-up was made with the use of 24-h AP monitoring. The INH course resulted in a significant decrease in systolic and diastolic AP, total peripheral vascular resistance. A morning rise of systolic pressure became slower. A favourable effect of normobaric hypoxia on AP 24-h rhythm was observed. A good hypotensive effect was achieved in 85.7% patients. A 6-month follow-up confirmed a long-term hypotensive effect of INH.     

24-hour arterial hypertension profile and heart rhythm variability in patients with arterial hypertension and NIDDM

The study covered 72 patients with non-insulin-dependent diabetes mellitus (NIDDM) whose mean age was 54.2 +/- 0.8 years, duration of the disease 8.6 +/- 3.6 years. They had also mild or moderate arterial hypertension mean duration of which was 12.4 +/- 4.3 years. The examination of the patients consisted of 24-h arterial pressure (AP) monitoring, Holter ECG monitoring, cardiointervalography. For eight weeks 19 patients received enalapril (5-20 mg/day), 14 patients were given felodipin (5-10 mg/day) and 15 patients were treated with valsartan (80-160 mg/day). Enhanced activity of the sympathetic nervous system in hypertensive subjects with NIDDM raises daily average values of systolic and diastolic AP, variability and speed of AP morning rise. In NIDDM patients with moderate arterial hypertension vegetative regulation of AP was more stressed than in mild hypertension. Optimal medication of NIDDM patients' arterial hypertension may consist of ACE inhibitors and antagonists of angiotensin II receptors. These drug lower stress of the sympathetic nervous system and thus promote normalization of daily profile of AP.     

Clinico-genetic aspects of the hypotensive response and regression of left ventricular hypertrophy in arterial hypertension patients

AIM: To study clinicogenetic determinants of left ventricular hypertrophy (LVH) regress in 52-week antihypertensive therapy to achieve the target arterial pressure (AP) < 140/90 mm Hg. MATERIAL AND METHODS: I/D-polymorphism of angiotensin converting enzyme gene, T174M-polymorphism of angiotensinogen gene, A1166C-polymorphism of angiotensin II ATI-receptor gene (ATII), 4a/b-polymorphism of endothelial NO-synthetase gene (eNOS) were determined in 64 patients (24 males, 40 females, mean age 54 +/- 1.1 years) with arterial hypertension (AH) and LVH. Echocardiography, laboratory tests, clinical measurements of blood pressure (BP) and 24-h AP monitoring were made after 4 weeks of placebo and 52 weeks of treatment. RESULTS: Baseline values of LV myocardium mass index (LVMMI) correlated significantly with mean 24 hour and night systolic arterial pressure; 24-h, day and night pulse pressure (PP). In patients with regress of LVH the degree of LVMMI reduction significantly correlated with lowering of day and night PP, baseline level of neutrophils, uric acid and creatinine 52 weeks after treatment. Groups made by polymorphism, did not significantly differ by initial LVMMI, frequency of achievement of target AP. In patients with genotypes ID/II and aa, the level of achieved diastolic arterial pressure was significantly lower than in other groups. Resistant LVH was seen in 42.2% patients. Frequency of AP normalization was higher in the group of patients with LVH regress (48.6% vs 25.9%; p < 0.05). Resistant LVH occurred more frequently in patients with genotype DD (64.0 vs 28.2% in patients with II/ID, p < 0.05) and in patients with genotype 4ab (62.9 vs 30.4% in patients with genotype aa and 21.4%--with genotype bb; p < 0.05 in both cases). In patients with resistant LVH frequency of DD genotype increased (59.3 vs 24.3% in patients with regress of LVH; p < 0.01), genotype AA (74.5 vs 48.6%; p < 0.01) and genotype ab (63.0 vs 27.0%, p < 0.01). CONCLUSION: Regress of LVH in AH patients depends on dynamics and complex interactions of some hemodynamic, laboratory and genetic parameters.