Remodelling and left ventricular diastolic function in relation to blood pressure variability in patients with arterial hypertension and coronary heart disease

Sixty five patients (mean age 55.7 ± 8,7 years), including 51 patients with arterial hypertension (AH) (mean age 54,9 ± 8,6 years) and 14 patients with a combination of AG and coronary heart disease (CHD) with postinfarction cardiosclerosis (mean age 54,9 ± 8,6 years) were examined. According to the values of average daily blood pressure variability (HPV), the patients were divided into subgroups with normal (11 patients with AH and 3 patients with AH and CHD) and increased (39 patients with AH and 12 patients with AH and CUD) BPV. Patients with isolated AH were found to have developed concentric hypertrophy of the left ventricle (LV), and moderate LV diastolic dysfunction mainly with impaired relaxation and the patients with a combination of AH and CHD with postinfarction cardiosclerosis had more significant LV structural and geometric derangements with a tendency for the development of eccentric hypertrophy of the LV, as well as more marked diastolic dysfunction with a larger proportion of the pseudo-normal and restrictive types of LV diastolic function. Patients with increased average daily BPV were found to have more significant LV structural, geometrical, and diastolic impairments.

arterial hypertension, coronary heart disease, blood pressure variability, left ventricular hypertrophy, left ventricular diastolic function

1. Беленков Ю.Н. Ремоделирование левого желудочка: комплексный подход. Сердечн. Недостаточность. 2002; 4 (14): 161-3.

2. Pfeffer M.A., Braunwald E. Ventricular remodeling after myocardial infarction: experimental observation and clinical implications. Circulation 1990; 81: 1161-72.

3. McKay R.G., Pfeffer M.A., Pasternak R.C., Markis J.E., Come P.C., Nakao S., Alderman J.D., Ferguson J.J., Safian R.D., Grossman W. Left ventricular remodeling after myocardial infarction: a corollary to infarct expansion. Circulation. 1986 Oct;74 (4):693-702.

4. Агеев Ф.Т., Овчинников А.Г. Диастолическая дисфункция как проявление ремоделирования сердца. Сердечн. недостаточность. 2002; 4 (14): 190-5.

5. Levy D., Garrison R.J., Savage D.D., Kannel W.B., Castelli W.P. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Mel.1990 May 31;322 (22):1561-6.

6. Prisant L.M., Carr A.A. Ambulatory blood pressure monitoring and echocardiographic left ventricular wall thickness and mass. Am J Hypertens. 1990 Feb;3 (2):81-9.

7. Кобалава Ж.Д., Котовская Ю.В. Мониторирование артериального давления: методические аспекты и клиническое значение. М., 1999.

8. Лышова О.В., Проворотов В.М. Всероссийский научно-практический семинар «Современные возможности холтеровского мониторирования»: Сб. тезисов. СПб., 2000: 53.

9. Frattola A., Parati G., Cuspidi C., Albini F., Mancia G. Prognostic value of 24-hour blood pressure variability. J. Hypertens. 1993 Oct;11 (10): 1133-7.

10. Shiller N.B. Two-dimensional echocardiographic determination of lefr ventricular volume, systolic function and mass summary and discussion of the 1989 recommendations of the American Society of Echocardiography. Circulation 1991: 84 (Suppl. 3): 1-280.

11. Ghali J.K., Liao Y., Cooper R.S. Influence of left ventricular geometric patterns on prognosis in patients with or without coronary artery disease. J Am Coll Cardiol. 1998 Jun;31 (7): 1635-40.

12. Koren M.J., Devereux R.B., Casale P.N., Savage D.D., Laragh J.H. Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Intern Med. 1991 Mar 1;114(5):345-52.

13. Oh J.K., Appleton C.P., Hatle L.K., Nishimura R.A., Seward J.B., Tajik A.J. The noninvasive assessment of left ventricular diastolic function with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 1997 Apr;10 (3): 246-70.

14. Хадзегова А.Б. Ремоделирование левого желудочка и психологический статус больных инфарктом миокарда. Автореф. дис…. д-ра мед. наук. М., 2001: 12-20.

15. Preffer M.A., Pasternak R.C., Markis J.E., Come P.C., Nakao S., Alderman J.D., Ferguson J.J., Safian R.D., Grossman W. Left ventricular remodeling after myocardial infarction: a corollary to infarct expansion. Circulation. 1986 Oct; 74 (4): 693-702.

16. Cuspidi C., Boselli L., Bragato R., Lonati L., Sampieri L., Bocciolone M., Leonetti G., Zanchetti A. Echocardiographic and ultrasonographic evaluation of cardiac and vascular hypertrophy in patients with essential hypertension. Cardiology. 1992;80 (5-6): 305-11.

17. Clement D.L., De Buyzere M., Duprez D. Left ventricular function and regression of left ventricular hypertrophy in essential hypertension. Am J Hypertens. 1993 Mar;6 (3 Pt 2): 1 4S-19S.

18. Cunha D.M., ds Cunha A.B., Martins W.A., Pinheiro L.A., Romeo L.J., de Moraes A.V., Morcerf E.P. Echocardiographic assessment of the different left ventricular geometric patterns in hypertensive patients. Arq Bras Cardiol. 2001 Jan;76 (1): 15-28.

19. Гогин Е.Е., Седов В.П. Неинвазивная инструментальная диагностика центрального, периферического, мозгового кровообращения при гипертонической болезни. Тер. Арх. 1999; 71 (4): 5-10.

20. Шустов С.Б., Барсуков А.Б., Аль-Язиди М.А. и др. Особенности ремоделирования у пациентов с артериальной гипертензией в зависимости от степени среднесуточной вариабельности артериального давления. Артериальная гипертензия 2002; 8 (2): 54-7.