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Different Types of Blood Pressure Variability in Hypertensive Patients with Chronic Lower Airway Diseases

https://doi.org/10.20996/1819-6446-2018-14-6-816-825

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Abstract

In hypertensive patients, blood pressure variability (BPV) and comorbidity are associated with prognosis. However, there have been no complex prospective studies of BPV in patients with hypertension and chronic lower airway diseases (CLAD). Aim. To investigate specific features of different BPV types and their prognostic value in hypertensive patients with and without CLAD in a prospective study. Material and methods. This prospective cohort study included hypertensive patients, approximately half of whom had asthma or chronic obstructive pulmonary disease (COPD). Clinic blood pressure (BP) measurements, ambulatory and home BP monitoring (ABPM, HBPM), spirometry, clinical blood analysis and blood chemistry, and a standard questionnaire and physical examination were performed at baseline and 12 months later. Clinical BP measurements and HBPM were also repeated 6 months after the baseline visit. At 12 months from the last study visit, we collected the information about cardiovascular complications and deaths. Statistical methods included ANOVA and survival analysis. The BPV indices were calculated as SD for different time periods, ARV (average real variability), and VIM (variation independent of mean). The inter-group comparisons were adjusted for age and sex. The assessment of intra-visit and long-term BPV was based on clinical BP measurement. The assessment of 24-hour BPV and mid-term BPV was based on ABPM and HBPM, respectively. Results. The BPV levels, assessed by ABPM and HBPM, were higher in patients with CLAD. There were no long-term BPV differences between two groups, in according to clinical BP data. Higher levels of daytime BPV were associated with orthostatic systolic BP, baseline forced expiratory volume in 1 second (FEV1), and glomerular filtration rate (GFR). An increase in nighttime BPV was associated with COPD, serum creatinine, FEV1 after β2-agonist inhalation, and GFR. In the CLAD group, the cumulative survival was lower, while the total risk was higher. The following endpoint predictors were identified: supraventricular arrhythmias, SD of nighttime diastolic BP, blood leukocyte count and nocturnal BP fall (Wald Chi-Square 14.780- 4.257; p<0.0001-0.026). Conclusion. The main BPV indices are higher in patients with asthma and COPD, in comparison with CLAD-free hypertensive patients. ABPM is the most reliable method of BPV assessment in hypertensive patients with CLAD, according to our data. The increase in BPV is associated with irreversible airway obstruction and renal function. Adverse outcomes were associated with both nighttime BPV and nocturnal BP fall, as well as with rhythm disorders and leukocyte count as a marker of systemic inflammation. BPV in patients with CLAD warrants further investigation.

About the Authors

M. I. Smirnova
National Medical Research Center for Preventive Medicine
Russian Federation
MD, PhD, Leading Researcher, Laboratory of Ambulatory Diagnostic Methods in the Prevention of Chronic Non-Communicable Diseases


V. M. Gorbunov
National Medical Research Center for Preventive Medicine
Russian Federation
MD, PhD, Professor, Head of Laboratory of Ambulatory Diagnostic Methods in the Prevention of Chronic Non-Communicable Diseases


A. S. Kurekhyan
Balashikha Municipal Hospital named after A. M. Degonsky
Russian Federation
MD, Cardiologist


Ya. N. Koshelyaevskaya
National Medical Research Center for Preventive Medicine
Russian Federation
Programmer, Laboratory of Ambulatory Diagnostic Methods in the Prevention of Chronic Non-Communicable Diseases


A. D. Deev
National Medical Research Center for Preventive Medicine
Russian Federation
PhD (Physics and Mathematics), Head of Biostatistics Laboratory


References

1. Celik M., Yuksel U.C., Yildirim E., et al. The relationship between blood pressure variability and Pooled Cohort Risk Assessment Equations 10-year cardiovascular risk score. Blood Pressure Monitoring. 2016;5(21):282-7. doi:10.1097/MBP.0000000000000200.

2. Parati G., Bilo G. Calcium antagonist added to angiotensin receptor blocker: a recipe for reducing blood pressure variability? Evidence from day-to-day home blood pressure monitoring. Hypertension. 2012:59;1091-3. doi:10.1161/HYPERTENSIONAHA.112.193037.

3. Mannino D.M., Thorn D., Swensen A., Holguin F. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur Respir J. 2008;32(4):962-9. doi:10.1183/09031936. 00012408.

4. The top 10 causes of death. WHO news, 24 May 2018. [cited by Dec 10, 2018]. Available from: http://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death.

5. GBD 2015 Chronic Respiratory Disease Collaborators Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Respir Med. 2017;5:691-706. doi:10.1016/S2213-2600(17)30293-X.

6. Corlateanu A., Covantev S., Mathioudakis A.G., et al. Prevalence and burden of comorbidities in Chronic Obstructive Pulmonary Disease. Respir Investig. 2016;54(6):387-396. doi:10.1016/ j.resinv.2016.07.001.

7. Karoli N.A., Rebrov A.P., Roshchina A.A. Features of the daily monitoring of blood pressure in patients with bronchial asthma. Saratov Scientific Medical Journal. 2008;4(4):42-6 (In Russ.)

8. Кароли Н.А., Долишняя Г.Р., Ребров А.П. Взаимосвязь суточного профиля артериального давления и суточного показателя жесткости артерий у мужчин с хронической обструктивной болезнью легких и артериальной гипертензией. Современная медицина: актуальные вопросы. Сборник статей по материалам XIII международной научно-практической конференции. Новосибирск: СибАК; 2012

9. Bazdyrev E.D., Gerasimova E.B., Polikutina O.M., et al. Cardiovascular risk factors in patients with chronic obstructive pulmonary disease. Clinician. 2014;1:22-7. (In Russ.)

10. van Gestel A.J., Clarenbach C.F., Stöwhas A.C., et al. The speed of blood pressure fluctuations in patients with chronic obstructive pulmonary disease. Heart, Lung and Circulation. 2014;3(23):280-6. doi:10.1016/j.hlc.2013.08.010.

11. Rogoza A.N., Nikol'skiy V.P., Oschepkova E.V. et al. Daily monitoring of blood pressure in hypertension. Methodical issues. Moscow: RKNKP; 1997 (In Russ.)

12. Oganov R.G., Deev A.D., Gorbunov V.M. Comparative informational content of various methods of analyzing the results of daily blood pressure monitoring in assessing the effectiveness of antihypertensive therapy. Cardiovascular Therapy and Prevention. 2003;1:17-25 (In Russ.)

13. Engström G., Wollmer P., Hedblad B., et al. Occurrence and prognostic significance of ventricular arrhythmia is related to pulmonary function: a study from "men born in 1914,"; Malmo, Sweden. Circulation. 2001;103:3086-91.

14. Mena L., Pintos S., Queipo N.V., et al. A reliable index for the prognostic significance of blood pressure variability. J Hypertens. 2003;23:505-11. doi:10.1097/01.hjh.0000160205.81652.5a.

15. Da J., Zhang Z., Shen Y., et al. Blood pressure variability is independent of systolic pressure in adolescent and young adult patients undergoing hemodialysis. Pediatr Res. 2018;83(3):615-21. doi:10.1038/pr.2017.293.

16. Rose G. Standardisation of observers in blood-pressure measurement. Lancet. 1965;7387(285):673-4. doi:10.1016/S0140-6736(65)91827-1.

17. Sharman J.E., Howes F., Head G.A., et al. How to measure home blood pressure: recommendations for healthcare professionals and patients. Aust Fam Physician. 2016;45(1):31-4.

18. Gorbunov V.M. Modern views on the variability of blood pressure. Rational Pharmacotherapy in Cardiology. 2012;8(6):810-8. (In Russ.)doi:10.20996/1819-6446-2012-8-6-810-818.

19. Chazova I.E. Optimization of antihypertensive therapy from the position of correction of increased blood pressure variability - an additional reduction in the risk of cardiovascular complications. Conclusion of the Council of Experts of the Russian Medical Society for Arterial Hypertension. Atmosphere. Cardiology News. 2013;1:29-32 (In Russ.)

20. Gorbunov V.M., Smirnova M.I., Volkov D.A. Problems of assessing seasonal blood pressure variability. Preventive Medicine. 2017;5:81-9 (In Russ.) doi:10.17116/profmed201720583-89.

21. Adasheva T.V., Fedorova I.V., Zadionchenko V.S., et al. Clinical and functional characteristics of arterial hypertension in patients with chronic obstructive pulmonary disease. Heart: A Journal for Practicing Physicians. 2009;6(8):345-50 (In Russ.)

22. Stergio G.S., Parati G. How to best assess blood pressure? The ongoing debate on the clinical value of blood pressure average and variability. Hypertension. 2011;57:1041-2.

23. Parati G., et al. Assesment and management of blood pressure variability. Nat Rev Cardiol. 2013;10:143-55. doi:10.1161/HYPERTENSIONAHA.111.172924.

24. Anthonisen N.R., Connett J.E., Enright P.L., et al. Hospitalizations and mortality in the Lung Health Study. Am J Respir Crit Care Med. 2002;166:333-9. doi:10.1164/rccm.2110093.

25. Cardiovascular prophylaxis (2017). Russian national recommendations. Russian Journal of Cardiology. 2018;23(6):7-122 (In Russ.)


For citation:


Smirnova M.I., Gorbunov V.M., Kurekhyan A.S., Koshelyaevskaya Y.N., Deev A.D. Different Types of Blood Pressure Variability in Hypertensive Patients with Chronic Lower Airway Diseases. Rational Pharmacotherapy in Cardiology. 2018;14(6):816-825. https://doi.org/10.20996/1819-6446-2018-14-6-816-825

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ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)