FEATURES OF HEART STRUCTURE AND FUNCTIONS IN PATIENTS WITH HYPERTENSION AFTER ISCHEMIC STROKE

Abstract

Hypertension leads to the myocardium and cardiac interstitium remodeling, causing a number of pathological changes: left ventricular myocardial hypertrophy, myocardial fibrosis, potentiation of ischemia, structural rearrangement and apoptosis of cardiomyocytes. Its other consequences are endothelial dysfunction and an increased stiffness of the main arteries. The whole complex of these changes forms a vicious circle and reflects the essence of change, i.e. the so−called "hypertensive heart". To assess the heart structural and functional state in hypertension, we examined 58 patients with stage III disease in the long term after ischemic stroke. In all patients the blood pressure was daily monitored and they were examined with Doppler cardiography. Left ventricular hypertrophy occurred in 51.8 % of cases: eccentric and concentric hypertrophy predominated, as well as concentric remodeling was recorded in only 6.9 % of the studied cases. Among the individuals without left ventricular hypertrophy, the daily non−dipper blood pressure profile was determined in 24.0 %, the night−peaker one was found in 12.0 %, dipper one was revealed in 56.0 %, and over−dipper was noticed in 8.0 % surveyed; while in the presence of hypertrophy, the prevalence of night−peaker increased significantly up to 14.3 % and non−dipper did to 33.9 %. In the patients with eccentric and concentric hypertrophy and persons with concentric remodeling, the daily non−dipper blood pressure profile was diagnosed in 32.0, respectively; 30.0 and 45.5 %, night−peaker − in 20.0; 10.0 and 9.1 %, dipper − in 48.0; 60.0 and 45.5 % of cases. The results show that the patients with stage III hypertension who have suffered an ischemic stroke undergo remodeling of the myocardium and cardiac interstitium, resulting in the formation of "hypertensive heart", that is an early clinically significant sign of the pathophysiological state of the cardiovascular system. Key words: arterial hypertension, ischemic stroke, heart remodeling, structural and functional features.