arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2015-21-4-416-425arthyper-306Research ArticleОРИГИНАЛЬНАЯ СТАТЬЯORIGINAL ARTICLEПоказатели артериального давления и распространенность артериальной гипертензии у больных акромегалией с обструктивным апноэ во время снаBlood pressure levels and hypertension prevalence in acromegalic patients with obstructive sleep apnoeЦойУ. А.TsoyU. A.

кандидат медицинских наук, ведущий научный сотрудник Института эндокринологии,

пр. Пархоменко, д. 15, Санкт-Петербург, 197156

MD, PhD, Leading Researcher, Institute of Endocrinology,

15 Parkhomenko avenue, St Petersburg, 197156

utsoi@mail.ruКоростовцеваЛ. С.KorostovtsevaL. S.

кандидат медицинских наук, научный сотрудник рабочей группы по сомнологии, научно-исследовательского отдела артериальной гипертензии

MD, PhD, Researcher, Sleep Medicine Group, Department for Hypertension,

St Petersburg

СвиряевЮ. В.SviryaevY. V.

доктор медицинских наук, руководитель рабочей группы по сомнологии, научно-исследовательского отдела артериальной гипертензии

MD, PhD, DSc, Head, Sleep Medicine Medicine Group, Department for Hypertension,

St Petersburg

СемёновА. П.SemenovA. P.

заведующий кардиологическим отделением № 2, младший научный сотрудник научно-исследовательской лаборатории патогенеза и терапии артериальной гипертензии

MD, Head, Cardiology Department № 2, Junior Researcher, Scientific Laboratory of Hypertension Pathogenesis and Treatment, Department for Hypertension,

St Petersburg

ВаулинаД. А.VaulinaD. A.

клинический ординатор

MD, Resident,

St Petersburg

КравченкоС. О.KravchenkoS. O.

клинический ординатор

MD, Resident,

St Petersburg

КонрадиА. О.KonradiA. O.

доктор медицинских наук, профессор, руководитель научно-исследовательского отдела артериальной гипертензии, заместитель генерального директора по научной работе

MD, PhD, DSc, Professor, Head, Department for Hypertension, Vice-Director on Research,

St Petersburg

ГринёваЕ. Н.GrinevaE. N.

доктор медицинских наук, профессор, директор Института эндокринологии

MD, PhD, DSc, Professor, Director, Institute of Endocrinology,

St Petersburg

Федеральное государственное бюджетное учреждение «Северо-Западный федеральный медицинский исследовательский центр имени В.А. Алмазова» Министерства здравоохранения Российской ФедерацииРоссияV.A. Almazov Federal North-West Medical Research CentreRussian Federation201504122015214416425Copyright © Цой У.А., Коростовцева Л.С., Свиряев Ю.В., Семёнов А.П., Ваулина Д.А., Кравченко С.О., Конради А.О., Гринёва Е.Н., 20152015Цой У.А., Коростовцева Л.С., Свиряев Ю.В., Семёнов А.П., Ваулина Д.А., Кравченко С.О., Конради А.О., Гринёва Е.Н.Tsoy U.A., Korostovtseva L.S., Sviryaev Y.V., Semenov A.P., Vaulina D.A., Kravchenko S.O., Konradi A.O., Grineva E.N.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/306

Артериальная гипертензия (АГ) является независимым фактором, увеличивающим риск смерти от сердечно-сосудистых заболеваний у больных акромегалией. Наиболее типичными дыхательными нарушениями при акромегалии являются обструктивные нарушения дыхания во сне (НДС). Существует мнение, что обструктивное апноэ во время сна (ОАС) вносит вклад в формирование АГ при акромегалии.

Цель исследования — оценить показатели артериального давления (АД) и распространенность АГ у больных акромегалией без предшествующего лечения в зависимости от наличия ОАС средне-тяжелой степени.

Материалы и методы

Материалы и методы. В исследование было включено 48 больных акромегалией (11 мужчин, 37 женщин, медиана возраста 53,5 (27–76) лет), ранее не получавших лечения основного заболевания. Всем пациентам выполнили оценку офисного АД, полисомнографическое исследование, суточное мо- ниторирование АД (СМАД).

Результаты

Результаты. Из 48 пациентов НДС были обнаружены у 36 (75%). Во всех случаях было выявлено ОАС. В тринадцати (36%) случаях диагностировано ОАС легкой степени тяжести, в 11 (31%) — средней и в двенадцати (33%) — тяжелой степени. Сравнивали показатели пациентов с ОАС средне-тяжелой степени (далее пациенты с ОАС) и без НДС. Офисное диастолическое АД было выше у пациентов с ОАС (p < 0,03). По данным СМАД показатели среднесуточного, дневного и ночного АД были значительно выше у больных акромегалией с ОАС. Количество пациентов с повышенными показателями офисного (χ² = 3,85, p < 0,05), среднесуточного (χ² = 4,8, p = 0,03) и ночного АД (χ² = 5,23, p < 0,03) по данным СМАД было существенно выше среди лиц с ОАС. Доли пациентов с повышением АД только в дневное время были сопоставимы в обеих группах (χ² = 3,55, p = 0,06).

Выводы

Выводы. Уровень АД и выявляемость АГ по результатам офисного измерения и по данным СМАД оказались выше в группе пациентов с ОАС средне-тяжелой степени по сравнению с группой без ОАС. Это подтверждает наличие вклада ОАС в формирование АГ при акромегалии. С учетом полученных результатов проведение полной полисомнографии целесообразно всем пациентам с впервые диагностированной акромегалией для выявления лиц с более высоким риском развития АГ.

Background

Background. Hypertension (HTN) is an independent factor of cardiovascular morbidity in acromegalic patients. Obstructive sleep disordered breathing (SDB) is the most common respiratory impairment in acromegaly and is considered one of the mechanisms underlying the development of HTN in acromegaly.

Objective

Objective. Тo assess blood pressure (BP) parameters and prevalence of HTN in naive acromegalic patients depending on the presence of moderate-to-severe SDB.

Design and methods

Design and methods. Forty-eight naive acromegalic patients [11 men, 37 women, median age 53,5 (27–76) years] were recruited into the study. All subjects underwent clinical examination including office BP measurement, full polysomnography, twenty-four-hour BP monitoring (24‑hour BPM).

Results

Results. SDB, namely obstructive sleep apnea (OSA), was found in 36 (75%) patients. Thirteen patients (36%) had mild, eleven (31%) — moderate and twelve (33%) showed severe OSA. The latter two groups (moderate-to-severe OSA, further referred as patients with OSA) were compared to patients without OSA (non-OSA). In patients with OSA office diastolic BP was significantly higher than in patients without OSA (р < 0,03). According to 24‑hour BPM mean 24‑hour, daytime and nighttime BP levels were significantly higher in patients with OSA as compared to non-OSA subjects. The rate of elevated office (χ² = 3,85; р < 0,05), mean 24‑hour (χ² = 4,8; р = 0,03) and nighttime BP (χ² = 5,23; р < 0,03) was significantly higher in OSA group, while the frequency of daytime HTN was similar in both groups.

Conclusions

Conclusions. According to the office measurement and 24‑hour BPM the BP parameters and HTN prevalence were higher in patients with OSA. According to our data, a polysomnography study should be recommended in patients with newly diagnosed acromegaly in order to detect ones at higher risk of HTN development

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