Aim. To study the relationship between symptomatic hypotensive episodes (SHEs) and parameters of self-monitoring of blood pressure (SMPB) in patients with hypertension (HTN).Material and methods. A total of 77 patients from 40 to 76 years old with HTN were examined. To identify SHEs, an original questionnaire was used. Patients underwent SMBP in the morning and evening, as well as recorded SHE in the diary. The self-monitoring period lasted 4 weeks. Patients without prior myocardial infarction and/or stroke are conventionally called “uncomplicated” HTN, while with cardiovascular events in history — “complicated” HTN.Results. According to the questionnaire, 48 (62,3%) patients noted SHEs. Uncomplicated HTN was recorded in 19 (51,4%) participants, while complicated one — in 29 (72,5%) (p=0,05). Blood pressure during SHEs was on average higher in patients with complicated HTN than in uncomplicated HTN (103/60 vs 95/60 mm Hg (p=0,05)). With a combination of uncomplicated HTN and SEG, mean systolic blood pressure (SBP) (125,9±10,5 vs 137,9±8,2 mm Hg), evening SBP (125,3±8,1vs 133,3±10,4 mm Hg), maximum SBP (149,8±11,8 vs 161,7±12,1 mm Hg) in the morning, as well as minimum SBP in the evening (101,8±10,8 vs 113,7±9,7 mm Hg) were lower than in patients without SHEs (p<0,05).In complicated HTN, an opposite relationship was observed: patients with SHEs had higher mean SBP (133,49±12,4 vs 118,93±15,3 mm Hg), maximum SBP (162,8±11,6 vs 141,7±12,0 mm Hg), and diastolic blood pressure (DBP) (91,5±5,6 vs 83,5±8,8 mm Hg) in the morning (p<0,05), as well as higher variability of morning (11,8±2,1 vs 8,2±2,7 mm Hg) and evening SBP (11,9±4,2 vs 8,6±3,2 mm Hg) compared with patients without SHEs (p<0,05). There were no significant differences in antihypertensive therapy.Conclusion. More than half of patients with hypertension report SHEs. SHEs in patients without prior myocardial infarction and/or stroke were characterized by lower blood pressure level than in subjects with prior cardiovascular events. Among patients with SHEs without cardiovascular events, the values of morning, evening, and maximum SBP in the morning are lower than in patients without SHEs. In patients with complicated HTN and SHEs, the opposite trend was observed: higher SBP and DBP in the morning, as well as greater variability of morning and evening SBP, in comparison with those without SHEs. These patterns cannot be explained by the antihypertensive drugs taken.
Цель. Определить встречаемость и выявить возможные взаимосвязи симптомных эпизодов гипотонии с клиническими характеристиками пациентов, прогнозом и режимом антигипертензивной терапии.Материалы и методы. Проведено кросс-секционное сравнительное исследование, обследованы 364 пациента с АГ в возрасте от 40 до 80 лет. В частности, пациенты стационара, перенесшие ИМ и/или инсульт, и амбулаторно наблюдавшиеся по поводу АГ, не переносившие сосудистых катастроф. Для ретроспективного анализа выделены пациенты, обратившиеся с впервые возникшими ОИМ или инсультом. Анализировалась медицинская документация, проводился опрос пациентов. Для выявления симптомной гипотонии использовался разработанный авторами опросник.Результаты и обсуждение. Среди всех испытуемых СЭГ отмечали 66,5%. У стационарных пациентов СЭГ встречались чаще (75,5%), чем у амбулаторных (56%), p<0,01. СЭГ чаще возникали у пациентов, перенесших ИМ, – 77,8%, инсульт – 76,3%, страдающих стенокардией напряжения – 76,1% и ХСН – 70,5% (p<0,01). По данным логистического регрессионного анализа стенокардия напряжения и перенесенный инсульт оказались независимыми факторами риска возникновения симптомной гипотонии (p<0,05). Ретроспективный анализ среди пациентов во время их первого острого кардиоваскулярного события показал, что у 72,6% из них отмечалось наличие СЭГ в анамнезе (p<0,01), что существенно чаще, чем у лиц с неосложненной АГ (p<0,05). 26,6% пациентов с неосложненной АГ отмечали плохое самочувствие при САД более 100 мм рт. ст., у остальных же симптомы гипотонии проявлялись при АД менее 100 мм рт. ст. Наличие ИМ, инсульта ранее сопровождалось более частыми СЭГ, при этом доля испытуемых с симптомами гипотонии при САД более 100 мм рт. ст. была достоверно больше (36,7%) в сравнении с амбулаторными пациентами (p<0,01). При наличии ИМ, инсульта в анамнезе вероятность возникновения СЭГ не зависела от режима терапии и была высока при регулярном (77,2%), эпизодическом приеме антигипертензивных препаратов (80%) и отсутствии антигипертензивной терапии (78,9%). Среди пациентов с неосложненной гипертензией СЭГвстречались достоверно реже при эпизодической антигипертензивной терапии (38,6%), в сравнении с регулярным лечением (65,9%) и его отсутствием (60,2%) (p<0,05).Заключение. Более половины пациентов с АГ отмечают у себя симптомные эпизоды гипотонии. У лиц со стенокардией напряжения, ХСН, а также ИМ, инсультом в анамнезе СЭГ возникают чаще, при этом СЭГ может быть фактором риска кардио- и цереброваскулярных событий. Частота СЭГ не зависит от регулярности приема антигипертензивных препаратов. Purpose. To analyze the frequency and possible relationships of the episodes of symptomatic hypotension with the clinical characteristics, prognosis, and antihypertensive therapy in hypertensive patientsMaterials and methods. A cross-sectional comparative study was conducted. We examined 364 patients with hypertension aged from 40 to 80 years. The study included patients, who had myocardial infarction and/or stroke, and outpatient ones, who did not have cardiovascular events. For retrospective analysis, the patients, who had the first appeared myocardial infarction or stroke were identified. Medical documentation was analyzed, a survey of patients was conducted. To identify symptomatic hypotension, a questionnaire developed by the authors was used.Results and discussion. Among all persons, the episodes of symptomatic hypotension are detected in 66.5%. In the group of hospitalized patients, most of them (75.5%) have the episodes of symptomatic hypotension. In outpatients, 56% have such episodes (p<0.01). Symptomatic hypotension is detected in 77.8% of patients, who had myocardial infarction, 76.3% with stroke, 76.1% with angina pectoris, and 70.5% of patients with chronic heart failure (p<0.01). During the logistic regression analysis, angina pectoris and stroke were the independent risk factors for symptomatic hypotension (p<0.05). A retrospective analysis among patients during their first acute cardiovascular event showed that 72.6% of them had a history of symptomatic hypotension episodes (p<0.01), which is significantly more than in patients with uncomplicated hypertension (p<0.05); 73.4% of patients with uncomplicated hypertension noted the symptoms of hypotension when systolic blood pressure was less than 100 mm Hg. The previous myocardial infarction, stroke accompanied by more frequent episodes of symptomatic hypotension, the percentage of subjects with hypotension symptoms with systolic blood pressure higher than 100 mm Hg was significantly higher (36.7%) if compared with outpatients (p<0.01). In patients with myocardial infarction, stroke symptomatic hypotensive episodes did not depend on the treatment regimen and was high with regular (77.2%), episodic (80%) or the absence of antihypertensive therapy (78.9%). Among patients with uncomplicated hypertension, symptomatic hypotensive episodes were significantly less frequent in episodic use of antihypertensive drugs (38.6%), in comparison with regular (65.9%) or absence of antihypertensive therapy (60.2%) (p<0.05).Conclusion. More than half of hypertensive patients suffer from episodes of symptomatic hypotension. Patients with angina pectoris, chronic heart failure, myocardial infarction, stroke have symptomatic hypotensive episodes more often. Symptomatic hypotensive episodes may be a risk factor for cardio- and cerebrovascular events. The frequency of hypotensive episodes is not clearly independent of the regularity of taking antihypertensive drugs.
This review considers the risk factors for arterial hypertension (AH) progression, obstructive sleep apnea syndrome (OSAS) and novel coronavirus infection (COVID-19) as potential variables for the prognostic models of estimating the probability of destabilization of the mentioned conditions. The most published studies consider AH and OSAS as the risk factors influencing the course of COVID-19, while moderate and mild COVID-19 can be destabilizing factor regarding to AH and OSAS. In addition, COVID-19, AH and OSAS are interrelated with sleep quality. The worsening of sleep quality often can be both a consequence of these diseases and a factor aggravating their course, and also can cause the increased vulnerability to acute diseases. An increased body mass index is a universal risk factor for many diseases and clinical conditions, and the monitoring of body mass increases the degree of the control of the diseases associated with obesity. In addition, the worsening of sleep quality can be both a consequence of any of above-mentioned conditions and a factor aggravating their course. Also, a promising direction for improving prognostic models is the analysis of autonomic dysfunction in patients.
Purpose Low blood pressure may be as harmful as high. Symptomatic hypotensive episodes should be a manifestation of circulatory disorders of hypertension – mediated organs especially among hypertensive patients. However, the association of such episodes with blood pressure variability is unknown. Aim To study the relationship between the symptomatic hypotensive episodes and the daily blood pressure variability according to the ambulatory blood pressure monitoring (ABPM) in patients with hypertension. Materials and methods 106 patients aged between 40 and 65 years with hypertension were studied. A questionnaire developed by the authors was used to identify symptomatic hypotension. During the study all the subjects had ABPM. Daily blood pressure variability was defined as standard deviation. Results Among all patients, symptomatic hypotensive episodes were observed in 60.6%. Among patients without myocardial infarction or stroke in anamnesis - 52.4%, with ones - 75% participants (p=0.05). Among patient without myocardial infarction or stroke and with symptomatic hypotensive episodes, the high variability of daily systolic BP was observed in 36% of the subjects and averaged 14.3 mm Hg, in the absence of symptomatic hypotensive episodes, the variability of daily systolic BP was 16.3 mm Hg, with a variety of blood pressure exceeding the norm, 80% of the participants (p<0.05). In case of stroke or myocardial infarction in anamnesis and the presence of symptomatic hypotensive episodes, the systolic BP variability of daytime (18.0 mm Hg) and nighttime (14.8 mm Hg) was the highest. The proportion of participants with daily systolic BP variability exceeding the norm was 78%. In the absence of symptomatic hypotensive episodes, the blood pressure variability indicators did not deviate from the norm (p<0.05). Conclusion Heart attack and/or stroke in anamnesis with symptomatic hypotensive episodes are associated with lower daily systolic BP variability (14.3 mm Hg) in comparison with patients without symptomatic hypotensive episodes (16.3 mm Hg). If there were stroke or myocardial infarction in anamnesis, patients with symptomatic hypotensive episodes have higher daily systolic BP variability (18.0 mm Hg) than without hypotensive episodes (14.5 mm Hg). Symptomatic hypotensive episodes are not unidirectionally associated with the variability of blood pressure, the character of the relationship is associated with the presence of heart attack and/or stroke diseases in anamnesis. FUNDunding Acknowledgement Type of funding sources: None.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.