Republished with permission from: Kardiologia Polska 2013; 71, 5: 441–446.

DOI: 10.5603/RH.2013.0089

Orthostatic hypotension is one of the forms of orthostatic instability associated with the high risk of unfavourable cardiovascular events. The definition of orthostatic hypotension includes the decrease of systolic blood pressure for more than 20 mmHg and diastolic — for more than 10 mmHg in 3-minute interval after verticalization. However, this general definition does not include all the forms of orthostatic hypotension. The article reviews classification, pathophysiology and some features of the pathology in special subgroups of patients, as well as diagnostics procedures and treatment options.

Objective. To assess the arterial baroreflex (BR) status in patients with resistant hypertension (RHTN) and find out relationships between the baseline BR sensitivity (BRS) parameters, its dynamics and degree of blood pressure (BP) decrease during long-term antihypertensive treatment.

Design and methods. We included 46 patients (22 males and 24 females, mean age 56 ± 6 years) with non-complicated RHTN and 46 patients (22 males and 24 females, mean age 54 ± 2 years) with controlled HTN (CHTN) at baseline, who achieved the goal BP with combined antihypertensive treatment (lisinopril 20 mg/d, amlodipine 10 mg/day, hydrochlorothiazide 25 mg/day). All patients underwent ambulatory 24-hour BP monitoring (ABPM) at baseline and BRS test at rest. ABPM and BRS test at rest were performed again after 12 months of treatment.

 Results. At baseline BRS in RHTN patients was lower than in CHTN patients (5,7 ± 2,1 vs 7,0 ± 1,4 ms/mm Hg, p < 0,05). RHTN patients who did not achieve goal BP showed lower BRS at baseline and at 12-month follow up (n = 11; 23,9 %) compared to RHTN patients with target BP (n = 35; 76,1 %).

Conclusions. BR dysfunction involving the decrease of spontaneous BRS at rest is associated with RHTN. The decrease of BP observed at long-term combined antihypertensive treatment is accompanied by the BRS increase in patients with RHTN and CHTN. Insufficient efficacy of antihypertensive treatment is associated with lower baseline BRS and low increase during follow up.

Background. Stress-induced hypertension is one of the clinical variants of masked hypertension. Along with behavioral and psychosocial risk factors (RF) of this type of hypertension, long-term variability of blood pressure (BP), being an independent predictor of cardiovascular events, is of high interest.

Objective. To evaluate the features of the RF and long BP variability in men with stress-induced hypertension in a one-year follow-up study.

Design and methods. We used «Mathematical account» to verify stress-induced hypertension, RF were assessed according to the recommendations, long-term hemodynamic variability was calculated based on traditional clinical measurement of BP and heart rate during the year.

Results. Men with stress-induced hypertension show a higher incidence of such RF as smoking, abdominal obesity, impaired lipid profile, family history of cardiovascular diseases, increased tolerance to salt, high levels of stress, personality type D, subclinical and clinical forms of anxiety and depression. We also found higher BP variability (both for systolic and diastolic BP) and for heart rate.

Conclusions. Stress-induced hypertension is associated with the higher prevalence of RF and hemodynamic variability that should be considered when prevention procedures are planned.

Design and methods. The office and ambulatory blood pressure (BP) were assessed at baseline, 1 week, 6 and 12 months after RD in patients with resistant essential hypertension who underwent bilateral transcatheter radiofrequency RD in single-arm prospective clinical study (ClinicalTrial.gov, NCT01499810).

Results. Fifty three patients were included (aged 53,8 ± 9,6 years, 28 males), 46 (87 %) and 39 (74 %) patients completed 6 and 12 months follow-up, respectively. Office BP at baseline was significantly higher than mean 24-h BP: 176,3/102,4 vs 158,2/93,3 mmHg, for systolic and diastolic BP, respectively, but rapidly decreased to its level 1 week after RD: 143,6/86,9 vs 145,9/87,3 mmHg. During the rest of follow-up period the office and ambulatory BP remained almost equal: 149,1/88,2 vs 148,5/87,2 mmHg at 6 months and 146,4/87,3 vs 145,7/85,6 mmHg at 12 months follow-up. Both office and ambulatory BP decreased significantly after RD, however, the effects were substantially different: -32,7/-15,5 vs -12,9/-7,0 mm Hg (office vs mean 24-h BP) at 1 week, -27,1/-13,3 vs -10,3/-6,2 mmHg at 6 months and -30,9/-15,1 vs -12,2/-7,8 mm Hg at 12 months after RD. At all follow up assessments the difference was almost equal to the baseline WCE.

Conclusions. Besides true BP reduction sympathetic RD also leads to the inhibition of WCE in patients with resistant hypertension. The difference between the decreases of office and ambulatory BP after RD may be totally explained by the elimination of significant baseline WCE. Inhibition of excessive BP reactivity to psychoemotional stress may have additional benefits.

Objective. To evaluate blood pressure (BP) lowering and dynamics of fasting glucose after transcatheter renal denervation (TRD) in patients with true resistant hypertension and type 2 diabetes mellitus (T2DM).

Design and methods. Twenty five patients with essential hypertension and T2DM with systolic BP (SBP) > 150 mmHg were included. Office BP measurement, 24-h ambulatory BP monitoring, renal Doppler ultrasound and assessment of fasting glucose and renal function (creatinine, estimated glomerular filtration rate) were performed at baseline and 6 months after TRD. None of the patients changed the antidiabetic and antihypertensive treatment during follow-up. Fourteen patients completed 6-month follow-up.

Results. TRD led to a significant reduction in systolic and diastolic 24-h BP (-22,7/-9,2 mmHg, p = 0,01/0,02), as well as office BP (-10,4/5,2 mmHg, p = 0,0005/0,01) and did not affect negatively renal function. Ten patients (71 %) were responders with the office SBP reduction > 10 mmHg. TRD was associated with significant reduction in fasting glucose levels  (-2,0 mmol/L, p < 0,05) at 6 month after the procedure and the increase of the number of the patient number with basal glucose level < 7 mmol/L (p = 0,002). At the same time basal glucose levels > 10 mmol/L were not registered after TRD (p = 0,01). Changes in fasting glucose did not correlate with the BP level reduction.

Conclusions. Renal denervation in patients with resistant hypertension and T2DM improves glucose metabolism besides the significant reduction in BP 6 months after the procedure.

Objective. To study the correlation of heart rate variability with daily profile of blood pressure (BP) in patients with essential hypertension (EH).

Design and methods. We examined 61 male with uncomplicated EH, aged 30–65 years (mean age 45,2 ± 7,6 years). We used spectral analysis at rest and during the functional tests (active tilt-test) to study the heart rate variability, and we performed ambulatory BP monitoring (ABPM). Based on the ABPM data, all patients were divided into 3 groups. The first group included 26 patients with normal nocturnal BP decline (10–20 % — dippers). The second group included 28 patients with insufficient nocturnal BP decline (< 10 % — non-dippers). The third group included 7 patients with excessive nocturnal BP decline (> 20 % — over-dippers).

Results. The most of the patients showed relatively normal autonomic heart regulation and were classified as dippers and over-dippers. Non-dippers demonstrated a reduction of sympathetic nervous system adaptive capabilities that was reflected by the decrease of LF-component against the normal reaction of HFmodulations.

Conclusions. The changes of daily BP profile in EH patients may be associated with the baroreflex failure reflected by the disadaptation reactions of HRV LF-component at tilt-test.

Objective. To establish the functional state of autonomic nervous system and its violations in teenagers with primary essential hypertension (PAH), and their influence on the course of the disease.

Design and methods. The type of an initial autonomic tone, vegetative reactivity and activity assurance was determined in 100 teenagers with PAH and was compared to the results of clinical and instrumental examination.

Results. Isolated sympathetic hyperactivity, excessive autonomic reactivity and activity assurance are associated with higher blood pressure (BP) and hypertension indices of time, and by the initial signs of myocardial remodeling. The increase of cholinergic activity is associated with the lower BP and hypertension index of time in teenagers.

Objective. Imidazoline receptor agonist moxonidine besides antihypertensive effect can increase insulin sensitivity, reduce leptin level, and improve lipid metabolism. However, the efficacy, tolerability and pleiotropic effects of moxonidine in postmenopausal women with essential hypertension (EH) and metabolic syndrome (MS) are not well established, and it was the purpose of this study.

 Design and methods. Forty-two postmenopausal women with EH and MS (mean age — 52,5 ± 0,4 years) were enrolled. Moxonidine therapy (400–600 mkg/ daily) lasted for 12 weeks. Waist (WC) and hip (HC) circumferences, WC/HC ratio, body mass index (BMI), insulin, leptin level, glucose, blood serum lipid profile, index of insulin resistance (HOMA-IR) and index of functional activity of pancreatic beta cells (HOMA-FB), echocardiography, intima-media thickness of common carotid arteries.

Results. Moxonidine therapy was associated with decrease, body weight and BMI decrease, high-density lipoprotein cholesterol and HOMA-FB index increase. Left atrium diameter and volume decreased, left ventricular diastolic function improved.

 Conclusions. Moxonidine is an effective antihypertensive drug for the treatment of postmenopausal hypertensive women with MS, which improves some metabolic, hemodynamic parameters and leads to the decrease of the left atrium volume and diameter.