INFLUENCE OF NOCTURNAL INCREASE OF BLOOD PRESSURE ON CARDIAC REMODELING IN PATIENTS WITH ARTERIAL HYPERTENSION

Actuality. Arterial hypertension (AH) is the main risk factor for the development of cardiovascular diseases, disability and cardiovascular mortality. Episodes of blood pressure (BP) increase during the day in patients receiving antihypertensive therapy are an unfavourable factor contributing to the development and progression of cardiac remodeling. Aim. The purpose of the research is to study the features of changes in the structural and functional state of the heart under the influence of high blood pressure at night in patients with arterial hypertension with the dynamic three-year observation. Material and methods. 47 patients with the diagnosis of AH were examined. Patients were divided into two groups, randomized by age, duration and severity of AH. Group 1 included 24 patients who as a result of ambulatory blood pressure monitoring (ABPM) on the background of combined antihypertensive therapy suffered from constantly increased BP at night. The second group combined 23 patients without the increase in BP during the night according to the ABPM with antihypertensive therapy. The examination included measurement of the office BP, ABPM, two-fold echocardiography with a three-year interval. Results. When assessing the indices of office BP in the groups, there were no significant differences, all patients achieved the target values of BP. In patients in Group 1, higher values of BP were observed during the day, according to ABPM. Echocardiography over a three year period of observation revealed a more pronounced increase in diastolic interventricular septum thickness, the thickness of the left ventricle posterior wall during diastole, sizes of left atrium in the patients of the first group, patients of the second group had a more pronounced thickness of the left ventricle posterior wall during systole. The increase in the size of the right ventricle was revealed in both groups. Conclusions. 1) In patients with the increase in blood pressure at night, the values of BP variability were higher during the day. 2) Three-year dynamic observation revealed that the increase in BP at night in patients with hypertension facilitated acceleration of cardiac remodelling and was associated with an increase in the left ventricular posterior wall, interventricular septum thickness, the size of the left atrium, and the size of the right ventricle.

hypertension, night increase in blood pressure, heart remodeling