Blood pressure target achievement in older adults with hypertension and chronic heart failure with preserved ejection fraction: the impact of adipose tissue function

Abstract

Objective. To assess the impact of adipose tissue dysfunction for target blood pressure levels achieving in arterial hypertension (AH) and chronic heart failure with preserved left ventricular ejection fraction (HFpEF) in real clinical practice.Materials and methods. We examined 91 elderly patients (> 75 y.o.) with AH and HFpEF during hospital admission. The mass and mass fraction of adipose tissue, serum levels of adipokines (adiponectin, leptin) and proinflammatory cytokines (TNFa and IL6) were assessed. Steady normotension at discharge was used as a marker of the target blood pressure level achievement possibility.Results. By the time of the planned discharge, stable normotension was recorded in 24.2% of patients. In senile patients with failure to achieve normotension, isolated systolic AH was most common - 55.1%. Patients with persistent hypertension at the time of the planned discharge were characterized by a low ability of adipose tissue to secrete adiponectin: 0.05 (0.03; 0.12) vs 0.37 (0.12; 0.5) μg/mL/kg (p = 0.037 ). The minimum values of adiponectin (corrected for adipose tissue mass) were in patients with systolic-diastolic AH (0.04 (0.03; 0.06) μg/ml/kg, Jonkhier-Terpstra test, p = 0.033). A regression model for achieving normotension in senile patients with HFpEF was built with a total percentage of correct classifications of 93.8% before bootstrap and 95.8% after: the maximum values of the Wald statistics were achieved with respect to the predictors "adiponectin", "TNF-a" and "heart rate".Conclusion. The development of adipose tissue dysfunction, accompanied by a decrease in the “rescue hormone” adiponectin synthesis, is associated with the failure to achieve normotension during medication of the inpatient treatment in senile patients with AH and HFpEF.