IDENTIFICATION OF ISOLATED HIGH BLOOD PRESSURE DURING WORK TIME, OPPORTUNE DIAGNOSTICS OF THE HYPERTENSIVE HEART DISEASE

Arterial hypertension (HTN) is the leading factor associated with myocardial infarction, stroke and premature death in the most countries. Annual prophylactic examinations in the organized populations aim at the HTN detection and related complications including the hypertensive heart disease (HHD). The isolated elevated blood pressure (BP) during work time (HTN at workplace, work-related HTN) is associated with the risk of HHD and other complications.

The aim of our study was the assessment of work-related HTN prevalence and echocardiography (EchoCG) measures in the employees of the big industrial enterprise who were not treated with antihypertensive medications.

Design and methods. This paper presents the results obtained from examination of workers not treated by the antihypertensive drugs (AHD) (n = 40). All subjects underwent physical examination, EchoCG, and 24-hour ambulatory BP monitoring (ABPM) Criteria of the work-related HTN were the combination of normal office BP level (< 140/90 mm Hg) and high BP (≥ 135 and/or 85 mm Hg) during the working hours (based on ABPM data within the period from 8 am till 5 pm).

Results. Among 477 employees of the industrial enterprise, who underwent ABPM and EchoCG within the annual prophylactic examination, only 185 (39 %) had normal office BP levels. Among them only 40 persons (21,6 %) did not take AHD, and met other inclusion/exclusion criteria. Based on ABPM data, only 20 employees (50 %) had normal office and ambulatory BP levels. EchoCG showed a high rate (60 %) of the concentric left ventricular hypertrophy (LVH), other forms of heart remodeling (HHD) were rare, eccentric hypertrophy was found in 5 %, and concentric remodeling — in 15 %. The prevalence of left ventricular remodeling types was comparable to that in stable HTN.

Conclusions. We believe that workrelated HTN is worth noting, in particular its early diagnosis and prevention is of great importance. ABPM at work place along with EchoCG for the detection of target organ damage should be included in the annual prophylactic examinations and will encourage the early diagnosis and timely cardiovascular prevention.

1. Бойцов С. А. Сердце как орган-мишень при артериальной гипертонии // Руководство по артериальной гипертонии / под ред. Е. И. Чазова и И. Е. Чазовой; М.: Медиа Медика, 2005. С. 201–216. [Boytsov SA. Heart as target-organ in arterial hypertension. In: Guidance for arterial hypertension / ed. by EI Chazov and IE Chazova; Moscow: Media Medica, 2005. P. 201–216. In Russian].

2. Горбунов В. М. Скрытая артериальная гипертония // Суточное мониторирование артериального давления. Современные аспекты. М.: Логосфера, 2015. C. 29–55. [Gorbunov VM. Masked arterial hypertension // 24-hours ambulatory BP monitoring. Modern aspects. Moscow: Logosphera, 2015. P. 29–55. In Russian].

3. Гогин Е. Е. Гипертоническая болезнь. М., 1997. 400 c. [Gogin EE. Hypertensive disease. Moscow, 1997. 400 P. In Russian].

4. Юренев А. П. Клинико-функциональная характеристика гипертонического сердца. Автореф. дис. ... д. м.н. Москва, 1983. [Jurenev AP. Clinical functional characteristic of the hypertensive heart. Thesis. Moscow, 1983. In Russian].

5. Georgiopoulou VV, Kalogeropoulos AP, Butler J. Prevention, diagnosis, and treatment of hypertensive heart disease. Cardiol Clin. 2010;28(4):675–691.

6. Оганов Р. Г., Шальнова С. А., Деев А. Д., Вихирева О. В., Гаврилова Н. Е. Распространенность артериальной гипертонии в России. Информированность, лечение, контроль. Профилактика заболеваний и укрепление здоровья. 2001;2:3–7. [Oganov RG, Shalnova SA, Deev AD, Vihireva OV, Gavrilova NE. The prevalence of arterial hypertension in Russia. Awareness, treatment, control. Diseases Prevention and Health Improvement. 2001;2:3–7. In Russian].

7. Профилактика, диагностика и лечение артериальной гипертензии. Рекомендации Российского медицинского общества по артериальной гипертонии и Всероссийского научного общества кардиологов. 2010. [Prevention, diagnosis and treatment of arterial hypertension. Guidelines of Russian Medical Society for Arterial Hypertension and Russian Scientific Society of Cardiologists. 2010. In Russian].

8. Рекомендации по лечению артериальной гипертонии. ESH/ESC2013. Российский кардиологический журнал. 2014;1(105):7–94. [Guidelines for Hypertension Treatment. ESH/ESC2013. Russian Journal of Cardiology. 2014;1(105):7–94. In Russian].

9. Devereux RB, Bella J, Boman K, Gerdts E, Nieminen MS, Rokkedal J et al. Echocardiographic left ventricular geometry in hypertensive patients with electrocardiographic left ventricular hypertrophy: The LIFE Study. Blood Press. 2001;10(2):74–82.

10. Pickerihg TG, Eguchi K, Kario K. Masked hypertension: a review. Hypertens Res. 2007;30(6):479–488.

11. Бритов А. Н., Платонова Е. М., Смирнова М. И., Горбунов В. М., Елисеева Н. А., Рыжова Т. В. и др. Морфофункциональные показатели миокарда у больных со скрытой артериальной гипертонией и гипертонией белого халата. Клиническая медицина. 2015;93(10):31–38. [Britov AN, Platonova EM, Smirnova MI, Gorbunov VM, Eliseeva NA, Ryzhova TV et al. Morphological-functional indices of myocardium in patients with masked hypertension and white coat hypertension. Clinical Medicine. 2015;93(10):31–38. In Russian].

12. Осипова И. В., Антропова О. Н., Головина К. Г., Лобанова Н. А., Зальцман А. Г., Калинина И. В. Особенности скрытой артериальной гипертонии у лиц операторской профессии. Артериальная гипертензия. 2010;16(3):316–320. [Osipova IV, Antropova ON, Golovina KG, Lobanova NA, Zaltsman AG, Kalinina IV. Masked hypertension in subjects with job stress. Arterial’naya Gipertenziya = Arterial Hypertension. 2010;16 (3):316–320. In Russian].