EFFECTS OF SMOKING ON CIRCADIAN ARTERIAL BLOOD PRESSURE PROFILE IN PATIENTS WITH NON-ST-SEGMENT ELEVATION ACUTE CORONARY SYNDROME AND CHRONIC KIDNEY DISEASE

Abstract

The paper presents the results of a study of the effects of smoking on circadian arterial blood pressure (ABP) profile in patients with Non-ST-Segment Elevation Acute Coronary Syndrome (NSTE-ACS) and Chronic Kidney Disease (CKD). Aim. The research aims at studying the features of circadian blood pressure monitoring (CBPM) in patients with NSTE-ACS and CKD, smoking-dependent. Materials and Methods. The study includes 70 patients with NSTE-ACS and CKD aged 35 to 75 years. The patients were divided into 2 groups: Group I - 35 smokers (mean age - 60.09±1.66 years), Group II - 35 individuals who have never smoked (mean age - 62.31±1.04 years). The circadian blood pressure monitoring was carried out on the second day of hospital admission after stabilization of the patient's condition. The following indicators have been determined: systolic blood pressure (SBP) - daytime, nighttime, and average daily (24 hours) (SBPd, SBPn, and SBPav); diastolic blood pressure (DBPd, DBPn, and DBPav); pulse pressure (PBPd, PBPn, and PBPav); time index (TI) for SBPd and SBPn (SBPd TI and SBPn TI) and DBP (DBPd TI and DBPn TI); heart rate (HR). To study the renal functional status in the examined patients, the urine albumin-creatinine ratio (ACR) was determined using the semi-quantitative method. The glomerular filtration rate (GFR) was calculated using the CKD-EPI Creatinine Equation. Results. Mean SBP, DBP, and PBP levels were significantly higher in Group I patients compared to Group II patients: SBPd - by 5.10% (p<0.05), SBPn - by 6.60% (p<0.05); DBPd - by 9.60% (p=0.01), DBPn - by 14.10% (p<0.05); PBPd - by 7% (p=0.05), PBPn - by 8.50% (p<0.05). The mean TI value also turned out to be significantly higher in the group of smokers (I) versus non-smokers (II): SBPd TI - by 55.50% (p<0.01), SBPn TI - by 58.90% (p<0.01), DBPd TI - by 57.50% (p<0.01), DBPn TI - by 46.30% (p<0.01). The HR was higher by 10.80% in Group I patients compared to Group II patients (p<0.01). The mean GFR level in smokers is 13.00% lower than in non-smokers (p<0.05). A 57% significantly higher ACR level was found in the group of smokers (Group I) compared to non-smokers (Group II) (p<0.01). Conclusions. Mean SBP, DBP, PBP, TI, and HR levels were significantly higher in the group of smokers with NSTE-ACS and CKD. In the same Group, more distinct signs of kidney injury were found, namely, lower GFR values and higher ACR values, which indicates the probable adverse effect of smoking on ABP regulation and renal microvasculature.