ORTHOSTATIC HYPOTENSION IN YOUNG AND MIDDLE-AGED HYPERTENSIVES: DOES IT RELATE TO TARGET ORGAN DAMAGE?
https://doi.org/10.18705/1607-419X-2014-20-4-62-71
Abstract
Objective. To investigate the incidence, clinical and hemodynamic characteristics of orthostatic hypotension (OH) in young and middle-aged hypertensive (HTN) patients by the head-up tilt test in relation to target organ damage.
Design and methods. Eighty-fi ve patients with HTN aged 47,0 (39,0–52,0) years and 40 healthy people aged 46,5 (33,0–51,0) years were examined. Head-up tilt test by Westminster protocol was performed. Hemodynamic parameters during the head-up tilt test and prevalence of OH were determined. We evaluated the target organ damage and antihypertensive therapy regimen in HTN patients with OH.
Results and conclusions. Tilt-induced OH was registered in 18,8 % of HTN patients and in 17,5 % of the control group (p > 0,05). In HTN patients the heart rate elevation during the test was lower than in healthy men [12,0 (7–19) and 16,0 (10–29) beats per minute; р < 0,01]. The myocardial mass [104,2 (94–112) и 88,5 (81–105) g/m 2; р < 0,05] was higher and carotid wall [1,5 (0,7–2,3) и 0,6 (0,5–1,0) mm; р < 0,05] was thicker as well as the signs of carotid atherosclerosis were found more often (50 and 18,8 %; р < 0,05) in hypertensives with OH, in comparison to those without OH.About the Authors
V. B. Boronova
Irkutsk State Medical Academy of Continuing Education, Irkutsk
Railway Hospital, Irkutsk
Russian Federation
Corresponding author: Railway Hospital, 10 Botkin st., Irkutsk, Russia, 664005. Phone: +7(3952)63–85–37. Fax: +7(3952) 38–13–54. E-mail: val6306@yandex.ru (Valentina B. Boronova, Postgraduate Student, Physician of the Internal Diseases Department at the Railway Hospital).
Russian Federation
Corresponding author: Railway Hospital, 10 Botkin st., Irkutsk, Russia, 664005. Phone: +7(3952)63–85–37. Fax: +7(3952) 38–13–54. E-mail: val6306@yandex.ru (Valentina B. Boronova, Postgraduate Student, Physician of the Internal Diseases Department at the Railway Hospital).
K. V. Protasov
Irkutsk State Medical Academy of Continuing Education, Irkutsk
Russian Federation
Russian Federation
N. B. Antonenko
Railway Hospital, Irkutsk
Russian Federation
Russian Federation
E. A. Petukhova
Railway Hospital, Irkutsk
Russian Federation
Russian Federation
S. V. Bakanach
Railway Hospital, Irkutsk
Russian Federation
Russian Federation
References
1. Лазебник Л.Б., Комисаренко И.А., Гусейнзаде М.Г. и др. Рекомендации по диагностике и лечению артериальной гипертонии у больных старших возрастов // Российский медицинский журнал. — 2003. — № 11. — C. 793–799. / Lasebnik L.B., Komisarenko I.A., Guseinzade M.G. et al. Recommendations for the diagnosis and treatment of arterial hypertension in older patients // Russian Medical Journal [Rossiyskii Meditsinskii Zhurnal]. — 2003. — № 11. — P. 793–799 [Russian].
2. Козловский В.И., Печерская М.С. Ортостатическая гипотензия у больных артериальной гипертензией. Отдаленные результаты лечения // Вестник ВГМУ. — 2009. — Т. 8, № 2. — C. 77–82. / Koilovskii V.I., Pecherskaya M.S. Orthostatic hypotension in hypertensive patients. Remote results of the treatment // Bulletin VGMU [Vestnik VGMU]. — 2009. — Vol. 8, № 2. — P. 77–82 [Russian].
3. Eigenbrodt M.L., Rose K.M., Couper D.J. et al. Orthostatic hypotension as a risk factor for stroke: the atherosclerosis risk in communities (ARIC) study // Stroke. — 2000. — Vol. 31, № 10. — P. 2307–2313.
4. Verwoert G.C., Mattace-Raso F.U., Hofman A. et al. Orthostatic hypotension and risk of cardiovascular disease in elderly people: the Rotterdam study // J. Am. Geriatr. Soc. — 2008. — Vol. 56, № 10. — P. 1816–1820.
5. Luukinen H., Koski K., Laippala P. et al. Prognosis of diastolic and systolic orthostatic hypotension in older persons // Arch. Intern. Med. — 1999. — Vol. 159, № 3. — P. 273–280.
6. Hajjar I. Postural blood pressure changes and orthostatic hypotension in the elderly patient: impact of antihypertensive medications // Drugs Aging. — 2005. — Vol. 22, № 1. — P. 55–68.
7. 2013 ESH / ESC Guidelines for the management of arterial hypertension // J. Hypertens. — 2013. — Vol. 31, № 7. — P. 1281–1357.
8. Brignole M., Alboni P., Benditt D. et al. Guidelines on management (diagnosis and treatment) of syncope // Eur. Heart J. — 2001. — Vol. 22, № 15. — P. 1256–1306.
9. Consensus statement on the defi nition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy // Neurology. — 1996. — Vol. 46, № 5. — Р. 1470.
10. Рабочая группа по диагностике и лечению обмороков Европейского общества кардиологов (ESC). Рекомендации по диагностике и лечению обмороков (2009) // Рациональная Фармакотерапия в Кардиологии. — 2010. — Т. 6, № 2. — С. 237–238. / The working group of the European society of cardiology (ESC) for the diagnosis and treatment of syncope. Recommendations for the diagnosis and treatment of syncope (2009) // Rational Pharmacotherapy in Cardiology [Ratsionalnaja Farmakoterapija v Kardiologii]. — 2010. — Vol. 6, № 2. — P. 237–238 [Russian].
11. Fedorowski A., Burri P. et al. Orthostatic hypotension in genetically related hypertensive and normotensive individuals // J. Hypertens. — 2009. — Vol. 27, № 5. — P. 976–982.
12. Головина Г.А., Дупляков Д.В. Ортостатическая гипотензия. Взгляд кардиолога // Артериальная гипертензия. —2014. — Т. 20, № 2. — С. 75–85. / Golovina G.A., Duplyakov D.V. Orthostatic hypotension: the cardiologist s view // Arterial Hypertension [Arterialnaya Gipertenziya]. — 2014. — Vol. 20, № 2. — P. 75–85 [Russian].
13. Gupta V., Lipsitz L.A. Orthostatic hypotension in the elderly: diagnosis and treatment // Am. J. Med. — 2007. — Vol. 120, № 10. — P. 841–847.
14. Атаханов Ш.Э., Робертсон Д. Ортостатическая гипотония и вегетативная недостаточность // Кардиология. — 1995. — № 3. — С. 41–50. / Atakhanov W.E., Robertson D. Orthostatic hypotension and autonomic failure // Cardiology [Kardiologiia]. — 1995. — № 3. — P. 41–50 [Russian].
15. Киселев А.Р., Караваев А.С., Гриднев В.И. и др. Сравнение динамики показателей вегетативной регуляции сердечно-сосудистой системы на фоне лечения эналаприлом и метопрололом у больных артериальной гипертонией // Саратовский научно-медицинский журнал. — 2010. — Т. 6, № 1. — С. 61–72. / Kiselev A.R., Karavaev A.S., Gridnev V.I. Comparison of dynamic of autonomic control indices in cardiovascular system under the treatment by ACE inhibitor (enalapril) and beta-blocker (metoprolol) in patients with hypertension // Saratov Journal of Medical Scientifi c Research [Saratovskii Nauchno-Meditsinskii Zhurnal]. — 2010. — Т. 6, № 1. — P. 61–72 [Russian].
16. Barochiner J., Alfi e J., Aparicio L. et al. Orthostatic hypotension in treated hypertensive patients // Rom. J. Intern. Med. — 2012. — Vol. 50, № 3. — P. 203–209.
17. Tomlinson L.A., Holt S.G., Leslie A.R. et al. Prevalence of ambulatory hypotension in elderly patients with CKD stages 3 and 4 // Nephrol. Dial. Transplant. — 2009. — Vol. 24, № 12. — P. 3751–3755.
18. Fan X.H, Wang Y., Sun K. et al. Disorders of orthostatic blood pressure response are associated with cardiovascular disease and target organ damage in hypertensive patients // Am. J. Hypertens. — 2010. — Vol. 23, № 8. — P. 829–837.
19. Протасов К.В., Боронова В.Б. Преходящая артериальная гипотензия у больных гипертонической болезнью: взаимосвязи с факторами риска и состоянием органов-мишеней // Артериальная гипертензия. — 2011. — Т. 17, № 6. — С. 531–536. / Protasov K.V., Boronova V.B. Transient arterial hypotension in hypertensive patients: relation to risk factors and target organ damage // Arterial Hypertension [Arterialnaya Gipertenziya]. — 2011. — Vol. 17, № 6. — P. 531–536 [Russian].
20. Gottdiener J.S., Yanez D., Rautaharju P. et al. Orthostatic hypotension in the Elderly: contributions of impaired LV fi lling and altered sympathovagal balance // Am. J. Geriatr. Cardiol. — 2000. — Vol. 9, № 5. — P. 273–280.
21. Rutan G.H., Hermanson B., Bild D.E., Kittner S.J., LaBaw F., Tell G. S. Orthostatic hypotension in older adults. The Cardiovascular Health Study. CHS Collaborative Research Group // Hypertension. — 1992. — Vol. 19, № 6. — Р. 508–519.
22. Fedorowski A., Ostling G., Persson M. et al. Orthostatic blood pressure response, carotid intima-media thickness, and plasma fi brinogen in older nondiabetic adults // J. Hypertens. — 2012. — Vol. 30, № 3. — 522–529.
23. Кузьмина Ю.В., Ощепкова Е.В., Рогоза А.Н. и др. Различные типы начальных ортостатических депрессорных реакций у больных гипертонической болезнью при активной ортостатической пробе // Терапевтический архив. — 2008. — Т. 80, № 4. — С. 38–42. / Kuzmina Y.V., Oshchepkova E.V., Rogoza A.N. et al. Various types of initial orthostatic depressor reactions in hypertensive patients with active orthostatic test // Therapeutic archive [Terapevticheskii Arhiv]. — 2008. — Vol. 80, № 4. — P. 38–42 [Russian].
24. Gianaros P., Jennings R., Olafsson B. et al. Greater intimamedia thickness in the carotid bulb is associated with reduced barorefl ex sensitivity // J. Hypertens. — 2002. — Vol. 15, № 6. — Р. 486–491.
25. Tonkin A., Wing L. Aging and susceptibility to drug-in-duced orthostatic hypotension // Clin. Pharmacol. Ther. — 1992. — Vol. 52, № 3. — Р. 277–285.
Review
For citations:
Boronova V.B., Protasov K.V., Antonenko N.B., Petukhova E.A., Bakanach S.V. ORTHOSTATIC HYPOTENSION IN YOUNG AND MIDDLE-AGED HYPERTENSIVES: DOES IT RELATE TO TARGET ORGAN DAMAGE? "Arterial’naya Gipertenziya" ("Arterial Hypertension"). 2014;20(4):255-261. (In Russ.) https://doi.org/10.18705/1607-419X-2014-20-4-62-71
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