arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2019-25-4-324-336arthyper-1837Research ArticleРЕДАКЦИОННАЯ СТАТЬЯEDITORIALФенотипы нарушений суточного профиля артериального давления и их ассоциации с воспалением и артериальной ригидностью у пациентов с ревматоидным артритомAbnormal phenotypes of 24-h blood pressure monitoring and their associations with inflammation and arterial stiffness in patients with rheumatoid arthritishttps://orcid.org/0000-0003-1756-7583ТроицкаяЕ. А.TroitskayaE. A.

Троицкая Елена Алексеевна — кандидат медицинских на­ук, доцент кафедры внутренних болезней с курсом кардиологии и функциональной диагностики имени академика В. С. Мои­сеева Медицинского института

ул. Вавилова, д. 61, Москва,  117292

6097-9775

Elena A. Troitskaya, MD, PhD, Associate Professor, De-partment of Internal Diseases with the Course in Cardiology and Functional Diagnostics named after V. S. Moiseev

61 Vavilova street, Moscow, 117292

troitskaya_ea@rudn.universityВельмакинС. В.VelmakinS. V.

Вельмакин Сергей Викторович — ассистент кафедры вну­тренних болезней с курсом кардиологии и функциональной диагностики имени академика В. С. Моисеева Медицинского института

Москва 

Sergei V. Velmakin, MD, Assistant, Department of Internal Diseases with the Course in Cardiology and Functional Diagnostics named after V. S. Moiseev

Moscow

vsergiov@mail.ruhttps://orcid.org/0000-0001-7652-2962ВиллевальдеС. В.VillevaldeS. V.

Виллевальде Светлана Вадимовна — доктор медицинских наук, профессор, начальник службы анализа и перспективно­го планирования, заведующая кафедрой кардиологии

Санкт-Петербург 

Svetlana V. Villevalde, MD, PhD, DSc, Professor, Head, Department of Analysis and Perspective Planning, Head, Department of Cardiology

St Petersburg

villevaldes@mail.ruhttps://orcid.org/0000-0002-5873-1768КобалаваЖ. Д.KobalavaZhanna

Кобалава Жанна Давидовна — доктор медицинских на­ук, профессор, заведующая кафедрой внутренних болезней с курсом кардиологии и функциональной диагностики имени академика В. С. Моисеева Медицинского института

Москва

 

Zhanna D. Kobalava, MD, PhD, DSc, Professor, Head, Department of the Internal Diseases with the Course in Cardiology and Functional Diagnostics named after V. S. Moiseev

Moscow

z.kobalava@mail.ruФедеральное государственное автономное образовательное учреждение высшего образования «Российский университет дружбы народов»РоссияPeople`s Friendship University of RussiaRussian FederationФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени В. А. Алмазова» Министерства здравоохранения Российской ФедерацииРоссияAlmazov National Medical Research CentreRussian FederationФедеральное государственное автономное образовательное учреждение высшего образования «Российский университет дружбы народов»РоссияPeople`s Friendship University of Russia (RUDN University)Russian Federation201920092019254324336Copyright © Троицкая Е.А., Вельмакин С.В., Виллевальде С.В., Кобалава Ж.Д., 20192019Троицкая Е.А., Вельмакин С.В., Виллевальде С.В., Кобалава Ж.Д.Troitskaya E.A., Velmakin S.V., Villevalde S.V., Kobalava Z.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://htn.almazovcentre.ru/jour/article/view/1837

Цель исследования — охарактеризовать суточный профиль периферического и центрального артери­ального давления (АД) у пациентов с ревматоидным артритом (РА) по сравнению с контрольной группой и изучить ассоциации выявленных нарушений.

Материалы и методы

Материалы и методы. В одномоментное поперечное ис­следование включено 85 пациентов с РА (22,4 % мужчин, возраст 59,7 ± 14,3 года, артериальная гипер­тензия (АГ) выявлена у 65 %, DAS28 (С‑реактивный белок, СРБ) 3,7 ± 1,1) и 40 пациентов контрольной группы, сопоставимых по основным клинико-демографическим параметрам. Всем проводилось изме­рение клинического АД, 24-часовое суточное мониторирование периферического и центрального АД (BPLab Vasotens), аппланационная тонометрия (SphygmoCor AtCor), оценка сердечно-сосудистого риска по шкале mSCORE (модификация EULAR). Результаты считали статистически значимыми при p < 0,05.

Результаты

Результаты. Частота контроля АД у пациентов с РА и АГ и в контрольной группе составила 58 % и 67 % (р = 0,48). Пациенты с РА и АГ по сравнению с группой контроля характеризовались более высоким кли­ническим, средним дневным, ночным и 24‑часовым периферическим и центральным систолическим АД (САД), пациенты с РА без АГ — более высоким ночным периферическим САД (113 ± 10 и 105 ± 9 мм рт. ст.; р = 0,02). У пациентов с РА в целом чаще выявлялись маскированная АГ (28,2 % и 7,5 %, p = 0,009), повышение ночного САД (56,5 % и 17,5 %, p < 0,001 в целом; 26,7 % и 0 %, p = 0,02 в группе без АГ), изо­лированная ночная АГ (30,6 % и 5 %, p = 0,001) и суточный профиль non-dipping (83,5 % и 62,5 %, p = 0,02). В однофакторном анализе установлены ассоциации ночного периферического САД с возрастом (r = 0,5), клиническим САД (r = 0,6) и диастолическим АД (ДАД) (r = 0,3), каротидно-феморальной (кф) скоро­стью распространения пульсовой волны (СРПВ, r = 0,5) и mSCORE (r = 0,5) (р < 0,05 для всех), профиля non-dipping — с возрастом (r = 0,22) и ночным периферическим и центральным ДАД (r = 0,36 и 0,35 со­ответственно), р < 0,05. Многофакторный регрессионный анализ подтвердил ассоциации между ночным САД и кфСРПВ (β = 0,43, p = 0,009), суточным профилем non-dipping и ночным периферическим ДАД (β = 0,57, p = 0,007). Лица с суточным профилем non-dipping («нон-дипперы») с повышением ночного САД характеризовались наиболее высокими значениями кфСРПВ, СРБ и mSCORE по сравнению с «дип­перами» и «нон-дипперами» с нормальным ночным САД.

Выводы

Выводы. Высокая частота повышения ночного САД у пациентов с РА не зависит от анамнеза АГ и коррелирует с повышением кфСРПВ; наличие су­точного профиля non-dipping ассоциировано с повышением ночного периферического ДАД. Сочетание профиля non-dipping с ночной АГ ассоциировано с повышением артериальной ригидности и сердечно-сосудистого риска на фоне более высокой воспалительной активности.

 

 

 

 

Abstract Objective

Abstract Objective. To evaluate the 24‑h profile of brachial and aortic blood pressure (BP) in patients with rheumatoid arthritis (RA) compared to the controls and to investigate the associations of the abnormalities.

Design and methods

Design and methods. The cross-sectional study included 85 patients with RA (males 22,4 %, aged 59,7 ± 14,3 years, hypertension (HTN) in 65 %, mean DAS‑28 (C‑reactive protein, CRP) 3,7 ± 1,1) and control group (40 patients matched by gender, age and risk factors). Office brachial BP was measured with a validated oscillometric device, 24-hour ambulatory blood pressure monitoring (ABPM) by BPLab Vasotens, arterial stiffness and aortic BP by applanation tonometry. Cardiovascular (CV) risk was calculated as mSCORE (EULAR recommended modified version). P < 0,05 was considered significant.

Results

Results. The rate of BP control was 58 % in RA and 67 % in the control group (p = 0,48). Patients with RA and HTN compared to matched controls had higher levels of brachial and aortic office, mean daytime, nighttime and 24‑h systolic BP (SBP), patients with RA without HTN showed higher brachial night SBP (113 ± 10 vs 105 ± 9 mmHg, р = 0,02). All patients with RA had higher rate of masked HTN (28,2 % vs 7,5 %, p = 0,009), night SBP and DBP elevation (56,5 % vs 17,5 %, p < 0,001; 26,7 % vs 0 %, p = 0,02, in the group without HTN, respectively), isolated nocturnal HTN (30,6 % vs 5 %, p = 0,001) and non-dipping (83,5 % vs 62,5 %, p = 0,02). Univariate analysis revealed significant associations of night brachial SBP with age (r = 0,5), office SBP (r = 0,6) and diastolic BP (DBP) (r = 0,3), carotid-femoral (cf) pulse wave velocity (PWV) (r = 0,5) and mSCORE (r = 0,5); non-dipping pattern was associated with age (r = 0,22) and night brachial and aortic DBP (r = 0,36 and 0,35, respectively), р < 0,05 for trend. Multivariate analysis confirmed independent associations of night brachial SBP with cfPWV (β = 0,43, p = 0,009) and non-dipping with night brachial DBP (β = 0,57, p = 0,007). Non-dippers with elevated night SBP had the highest levels of cfPWV, CRP and mSCORE compared to dippers and non-dippers with normal night SBP.

Conclusions

Conclusions. High incidence of night SBP elevation does not depend on the history of HTN and is associated with cfPWV increase. Non-dipping state correlates with elevation of night brachial DBP. Combination of non-dipping state with night HTN is associated with arterial stiffness and higher CV risk. Inflammation might mediate these associations.

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The authors declare that there are no conflicts of interest present.