Predictors of cardiovascular complications in patients with arterial hypertension and comorbid pathology

Abstract

Aim. To study the relationship between central arterial pressure (BP) and cystatin C in patients with arterial hypertension and comorbid pathology, depending on gender differences. Materials and methods. The study involved 162 patients aged 39 to 82 years, suffering from hypertension and comorbid pathology. The average age of the surveyed was 58.610.3 years. The following nosological forms were revealed: coronary heart disease 40.7% of the examined, overweight 33.9%, 1st degree obesity 30.8%, type 2 diabetes mellitus 29.0%, chronic obstructive disease lungs 16.6%, cerebrovascular diseases 13.5%. All participants underwent general clinical examinations. The concentration of the lipid spectrum was investigated: the levels of total cholesterol, triglycerides, cholesterol high density lipoproteins (HDL cholesterol) and low density lipoprotein cholesterol (LDL cholesterol) and plasma cystatin C. Glomerular filtration rate (GFR) was calculated according to F. Hoek's formula (80.35/cystatin C 4.32=GFR). Study of central aortic pressure (CAP), mm Hg Art., was carried out using the device "AngioScan". Echocardiography was performed on a "Vivid q" apparatus (USA, 2014) according to the generally accepted technique. All examined patients were divided into 2 subgroups. The 1st subgroup includes women, the 2nd men. Results. In patients with hypertension and comorbid pathology, the most common abnormalities were an increased level of LDL cholesterol (58%), a decreased level of HDL cholesterol (51.8%), hypercholesterolemia (54.3%), hypertriglyceridemia (43.8%) and tachycardia (40.7%). In 51.8% of the surveyed, and more among males, the achievement of the target blood pressure level was detected. In women, the indicators of average age, body mass index, the content of total cholesterol, LDL cholesterol and HDL cholesterol were significantly higher. In male patients, the indicators of the diameter of the aortic outflow tract, end systolic and diastolic dimensions of the left ventricle (LV) significantly exceeded those of women, and the ejection fraction of the LV was significantly lower. The prevalence of LV hypertrophy (LVH) was 37% in the total sample, and it was higher in women than in men (45.9 and 26.6%, respectively, p=0.012). At the same time, the frequencies of concentric and eccentric types of LVH in both subgroups were similar. The incidence of LV concentric remodeling in women and men was 5.7 and 13.3%, respectively (p=0.001). In both subgroups, a negative correlation was found between the LV myocardial mass index and the calculated GFR. A positive correlation was noted between the levels of systolic blood pressure and CAP, the concentrations of cystatin C and plasma triglycerides. Conclusion. In hypertension, the structure of comorbid pathology is dominated by coronary heart disease, obesity and type 2 diabetes mellitus, when hyper- and dyslipidemia were often detected. The incidence of LVH in the general group of subjects was 37.0%, and in women this indicator was higher. In the subgroup of men, cases of LV concentric remodeling were significantly more frequent. An increase in the level of CAP and systolic blood pressure, as well as the concentration of cystatin C, was associated with an increase in the LV myocardial mass index, especially in the subgroup of women.