1Kazakh National Medicine University - Almaty - Kazakhstan
The purpose: This study examined the circadian blood pressure profile in patients with decompensated chronic pulmonary heart (dCPH) disease in combination with arterial hypertension (AH) of the 1st and 2nd degrees using ambulatory blood pressure monitoring (ABPM).
Materials and Methods: 102 patients were studied using ABPM. The mean age was 65,6 ± 2,9 years. The patients were divided into 3 groups: the first group - 36 patients with dCPH of functional class (FC4) (NYHA) and combined with AH of the 1st degree RF4, second – 36 patients with dCPH of FC4 (NYHA) associated with AH of the 2nd degree RF4, 3rd control group included 30 patients with dCPH FC4 (NYHA).
Results: Patients with dCPH have an increase of night diastolic blood pressure (DBP) to 80,05±2,7mm.Hg (normally 75 mm.Hg) (?<0,05), which is likely due to increase of pulmonary hypertension and the absence of nocturnal physiologic blood pressure decrease, which may be a sign of the formation of the so-called "pulmonary" arterial hypertension.
At association of AH 1 and 2 degree the increase of night DBP was higher (86,05±1,7mm.Hg and 100,1±1,8 mm.Hg) (?<0,01), than in patients with dCPH, which was possibly due to a combination of "pulmonary" diastolic hypertension and superimposed arterial hypertension.
In patients with AH the time indices significantly increase, which testify to marked impact of load falling on target-organs not only due to an increase of blood pressure, but also to decompensation of cardiopulmonary failure. So, time index of systolic BP (TISBP) in 1st group in daytime increased up to 65,7 ± 4,7% and in 2nd group up to 87,4 ± 2,7% (p <0.05). Time index of DBP (TIDBP ) was up to 43,5 ± 4,9 (p <0.01) in patients in 1st group, and 74,1 ± 3,0% (p <0.01) – in 2nd group.
In the night in 2nd group TISBP made 93,05 ± 4,3% (p <0.01), in 1st group - 77 ± 4,8%. TIDBP at night was equal to 90,9 ± 4,3% (p <0.01) in the 2nd group. In 1st group this index was equal to 79,5 ± 8,1%.
Mean pulse pressure was increased up to 63,83 ± 1,3 mm Hg (p <0.01) in 2nd group, that was 15% higher than in the 1st group (norm of PBP is 53 mm Hg).
The magnitude of the morning rise of DBP in 2nd also increased, it was 10% above the norm reaching 40,3 ± 3,7 mm Hg (p <0.01). Conclusions: The result revealed that the features of hypertension in patients with decompensated chronic pulmonary heart disease is a significant increase of night DBP, increase of pulse pressure and the value of morning rise in DBP, the increase of the load on the target organs. All above-mentioned may lead to an increased risk of cardiovascular complications.